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7 


HAND-BOOK 


OF 


VETERINARY SURGERY 


AND 


OBS] EARNtGs 


WITH CO-OPERATION 


OF 


ProF. Dr. ALBRECHT (MuNICH), STAFF VETERINARIAN BARTKE 
(STETTIN), PROF. DE BRUIN (UTRECHT), PRoF. CADIOT (ALFORT), 
Pror. Dr. EBERLEIN (BERLIN), PROF. DR. GMELIN (STUTTGART), 
STAFF VETERINARIAN HELL (ALTONA), PRoF. HENDRICKX (BrRus- 
SELS), PROF. DR. HESS (BERN), PRoF. Dr. HIRZEL (ZuRICH), STAFF 
VETERINARIAN KONIG (KONIGSBERG), PROF. LANZILLOTTI-BUON- 
SANTI (MiLan), Docent LUNGWITZ (DRESDEN), PROF. DR. 
OSTERTAG (BERLIN), PROF. DR, PFEIFFER (GIESSEN), PROF. DR. 
SCHINDELKA (VIENNA), DR. SCHMIDT (VIENNA), LATE PROF. 
Dr. SIEDAMGROTZKY (DRESDEN), PROF. DR. VENNERHOLM 
(STOCKHOLM), PROF. Dr. ZSCHOKKE (Ztrich). 


HDITED BY 


PROFESSOR DR. JOS. BAYER and Prorgessor Dr. EUG. FROHNER 
VIENNA BERLIN 


NOT Li. 


GENERAL SURGERY 


Y; 
Dr. EUGEN FROHNER 


THIRD EDITION 


1905 


GENERAL SURGERY 


BY 


DR. EUGEN FROHNER 


PROFESSOR IN THE, ROYAL VETERINARY COLLEGE IN BERLIN 


Authonzed Translation From 


THE THIRD REVISED EDITION 


BY 


D. HAMMOND UDALL, B.S.A., D..V.M. 


ASSOCIATE PROFESSOR OF SURGERY AND OBSTETRICS 
COLLEGE OF VETERINARY MEDICINE 


OHIO STATE UNIVERSITY 


Columbus. 


TAYLOR & CARPENTER 
ITHACA, N. Y. 
1906 


= 


a 


a BS 


ge Dae AV A ew” 9 foe Ne ey te 


Piva eaAG ha lLO WH RoRM RS RDUITION, 


In the following hand-book of veterinary surgery and ob- 


.stetrics the general surgery, as well as the operative surgery, 


forms a separate, independent work. In a sense they serve as 
an introduction to the following third and fourth volumes of 
special surgery of the different organs. ; 

Any text-book of general veterinary surgery must depend 
on the investigations and text-books of human medicine. 
While I have kept this point in view in the development of 
the following plan, I think I have clearly drawn the relations 
between the general surgery of man and animals. I also 
admit that in the writing of this book I have followed princi- 
pally the plans which Billroth, and recently Tillman, have 
used in their text-books of human and general surgery. 

The reader will readily note that the following work is nota 
mere compilation of the books mentioned on human medicine. 
In many particulars veterinary surgery, like pathology, phar- 
macology and therapy, has developed independent lines. Many 
chapters on human surgery have no connection with veterinary 
surgery ; other divisions that are very important in human 
surgery are of little or no importance in veterinary science. 
Tuberculosis of the bones and joints, for example, belongs to 
one of the most important divisions of human surgery ; in 
veterinary surgery it is practically never the occasion for 
surgical interference. 

Conversely, actinomycosis and botryomycosis is of great 


‘Importance in veterinary surgery, the latter is almost unknown 


in man. In man osteomyelitis is the most important form of 
inflammation of the bones ; in the horse periostitis is the most 
important form. Erysipelas, so frequent in man, appears to 
be very rare in animals. It is obvious that resection of joints, 
as well as most amputations of limbs, cannot be employed on 


(V) 


VI PREFACE. 


domestic animals. The aseptic method, which is so important 
in human surgery, seems to be of little importance in veteri- 
nary science because of purely external causes. Even bone- 
fractures present an entirely different surgical problem in large 
animals than in men. Firing, and the application of blisters 
for chronic inflammations of bones, tendons, and joints, are 
, special surgical methods of veterinarians. 


On the other hand, the following work is not a compen- 
dium of other surgical text-books on veterinary surgery. On 
the basis of many years of surgical and clinical activity, I 
think I have had sufficient experience to elucidate the follow- 
ing subject from my own point of view. In many chapters, 
namely, those on fractures and tumors, I was in a position to 
insert my own investigations. I was also careful to arrange 
the material purely from a veterinary standpoint, and only for 
the object of veterinary practice. On this basis the reader will 
find, for example, many references in this book to forensic 
veterinary science (age of wounds, fractures, fissures, muscular 
atrophy; curability or non-curability of bone-fractures in 
horses and cattle; abnormal fragility of bones ; prophylaxis 
of bone-fractures, etc.). Foreign bodies, parasites, and con- 
genital new-formations, which are of great surgical import- 
ance, have been given special attention. 

General surgery has numerous and important relations to 
general pathology and pathological anatomy. Unfortunately 
we have no text-book of general pathology in our veterinary 
literature. On the other hand we have recently come into 
the possession of a very important hand-book of veterinary 
pathological anatomy. I am under great obligations to this 
excellent book of Kitt’s for valuable suggestions and informa- 
tion. General surgery is also closely related tu anatomy. I 
have found a deficiency in the descriptions of tendon-sheaths 
and fasciz in most veterinary text-books on anatomy ; these 
are very important from a surgical standpoint, the descriptions 
are usually incomplete and indistinct. With reference to the 
relation of general surgery to bacteriology, it must be acknowl- 
edged that the latter has contributed largely to the problem of 
suppuration and inflammation, as well as to the combating of 


Ear, 
mas 


PREFACE. VII 


these processes by means of antiseptics, from a standpoint of 
both scientific and practical surgery. On the other hand, one 
must not overestimate the importance of bacteriology to general 
surgery and overlook everything else for bacteria. Many 
surgical inflammations have nothing to do with bacteria ; this 
is especially true of the purely traumatic, aseptic inflammations 
of bones, joints, tendons, tendon-sheaths, and muscles. At 
suitable places I have considered it my duty to repeatedly 
refer to this obligation. From a diagnostic standpoint also, 
bacteriology should not be given too great weight in surgery. 
Pus-cocci, in particular, are of little practical diagnostic impor- 
tance ; this is especially true where the candidate, unfortu- 
nately, is overenthusiastic concerning the significance of a 
bacteriological examination, to him the presence of pus-forming 
bacteria in pus from bones may form the principal evidence for 
the presence of a bone-fistula. The bacteriological confusions 
that have occurred concerning wound-erysipelas receive atten- 
tion in the chapter on this subject. 

There is no claim of completeness for the bibliography at 
the end of each chapter. My principal object was to divide 
the literature on human medicine from that of veterinary scl- 
ence and, above all, also to indicate to students the funda- 
mental investigations that have been made in human medi- 
cine; only the most important and recent works have been 
mentioned. 

The book contains no illustrations. I am opposed to the 
usual custom in veterinary science of appropriating illus- 
trations from works on human medicine, either unchanged or 
specially modified. I maintain that it is not admissible. 


KISSINGEN, August, 1896. 


PREFACE TO THE THIRD EDITS 


The new, third edition of general surgery is improved and 
enlarged in many respects. The individual changes are as 
follows: The chapter on the etiology of tumors has been re- 
written, and many additions have been made to the casuistry 
of this group; unfortunately the recent etiological works on 
tumors are largely speculations. The chapter on botryomy- 
cosis has been newly written to harmonize with the most re- 
cent investigations on this subject; there is hardly a doubt 
that in this wound infection we have to deal, not with staphy- 
lococci, but with an infectious disease sui generis. Regardless 
of the objections of critics, the chapter on tuberculosis has 
been retained and even enlarged ; the motive for following this 
plan is explained in that chapter. I have supplemented the 
important chapter on chronic deforming arthritis with the re- 
sults of recent investigations made in my clinic upon ringbones 
chronic gonitis, and omarthritis.. This is also true of primary 
infectious osteomyelitis the occurrence of which in the horse, 
according to our recent investigations, can be no longer 
doubted. Recent investigations on myositis, neuritis, healing 
of fractures, necrosis bacilli, pseudo-edema bacilli, and foal- 
lameness have also been considered. On the subject of asepsis 
against antisepsis it may be definitely stated that now, even in 
human therapeutics, all have returned to antisepsis. In the 
first edition of this book I recommended antisepsis for the vet- 
erinary surgeon. Even for the disinfection of fresh wounds 
the application of pure carbolic acid, as well as the hot iron, 
has been recently recommended in human surgeries. 

What a change within one decade ! 

Berlin, December, 1904. 

ProF. Dr. FROHNER. 


(VIII) 


TRANSLATOR’S PREFACE 


The translation of the third edition of Frohners ‘‘ General 
Surgery ’’ has been undertaken to supply a well classified pre- 
sentation of the fundamental principles of surgery. It is hoped 
that it may assist the beginner in obtaining a clear perspective 
of the mass of surgical diseases with which he must come in 
contact. 

That portion of the text dealing with bibliography has 
been omitted in the translation as it is practically unavailable 
to most English readers. Otherwise the text has been closely 
followed, no additions or other changes having been made. 

The translator of this work is especially indebted to Pro- 
fessor David Stuart White who has rendered valuable assist- 
ance in reading the proof sheets. He is also indebted to Drs. 
A. D. Fitzgerald and James Mcl. Phillips for suggestions that 
have materially reduced the list of errors. 

The translator wishes to express his gratitude to the firm 
of Taylor & Carpenter who have procured the authorization 
of this translation from the German publishers, assumed all 
financial responsibility, and shown every possible courtesy and 
assistance in furthering the progress of the work. 

Deis LLL, 
Columbus, Ohio, July, 1906. 


(IX) 


CONTENTS 


PAGE 

UA ES on ss nn Uae eS i ea SAREE a ee ya phe dh Amr)... Wi Weare ele V 
TIESTO eee rei ae oli, Sh i ee ef ee he Gi 
etter eam oo aC. oe Se Ay se Ne 2 Seen Er I 
I. Definition, Classification, and Symptoms_______._____.__- I 


II. Incised, Stab, Contused, Shot, Lacerated, and Poisoned 


UNG EE Cy 85 SUN ae OS Lean a I eS 6 
BTL TOL Orr Tremor nage 2 ye pie ee ee oe ee re 
mewn diatomical Changes in Wound Healing 92 ooe 25S sy 

POM Nie CtlOl siccasese sun ce os Ses 25 
PEUTIC tO tee ee Stee aes 2S a Ne ee fee 25 

2 QRAGIORSTUGNS: nen 8 OME Det NTs Se Ge olathe! Up mais week eges 57 28 

pam ac Cas eee ee er le ee 34 

TR OU ee Vette eee eres Pee 37 

RRO UClGr tir meee ens Nee Ny ee eke 4o 

mn We trl eee et we ea 44 

7. Other Wound Infection Diseases _...___ 2a 46 
MisePreatitetio-Of WOUuNdS: 2 = 2 eee dL es tk Pe Seale se 55 
Subcutaneous Injuries of Soft Parts, (Contusion, Rupture) ______ 64 
POE ISG tt eee ens es le ee 64 

eee Ct EtG em meemee mr se So 2 8 hes woe BU ADDL. 70 
OE PSV S ITV EELS soe Rien tee Ss __ 2008 SE gs) se Ue amen a Os ee 72 
Mee APS era ASAUSCS eae! LE ee ec Se J2 

II. Kinds, Symptoms, and Course of Inflammation __________ 76 
Miemelreatment of inflammation: 2) yo) se 79 
Bieereristuin,Gangrene.-91 2° 25322. 54. 0-2 ee ks 84 
1 SRLS Runde yt She, gies San REE aig te 2h: RE eee ee 84 

Vg SEN ata EW get 2 SANS sie Riedel ARC PERE es A a Re ORI Ae 86 
MUI LO Cerrar ee oe ao rete a ee ee eh Se gt 
TYLA Rs pe hw SS EEE Sy aS i UR On 5 1 EP hae Ye 98 
DUPE CUOLSH Mire GCrols cea co ee ee fe 98 
EOE Clete s-OF o LM Ofod 2c io eee elie ee ee 107 


1 ; CONTENTS 


A. Connective-tissue Néw Formations. _o 22 ee 107 
EES Pibroma <a oS ee 107 
23) TL Aponig 2107 Ge a iid 
3. SEY OMe C2220 la 2 es 116 
* 4.3 \Chondroma os. 22052 Si ee 
het Osteoma os. oo oe ee ee 119 
6. aM yoma =. 255 oe ee a ee 120 
7. @ NBUrOMa 2. oo See ee ee ee TZT 
S)SAnpioma i202 le 122 
9:3 Lymphoma = 23.5002 2 Sooo ee ee ee 124 
Loc Sarcoma.) USL ee se ee 125 
Bo £epithelial New Formationsic2. eee 133 

z. Carcinoma Ce eu Ase 123%. 
2. Papilloma 22 (025 oe ee 144 
3, “Adenoma ._ ooo oe eee 147 
CS Cystic LUMOrs olen eR ee eee 149 
DM infectious 1 amors. 3 Se a eee 152 
i.) -Actinomycoma..2_2 4. 3) 4 eee 152 
2. Botryomycomal_._. [i 35 pes eo ee ee 161 
3... Tuberculosis <i) 22.u2 Ee 166 
Concrements and Foreign Bodies... 2.220402) so 174 
i... :‘Concrements (215. (20S se 2 174 
Il., Foreign Bodies .2.02---_.L-.. (oes 178 
Hernia and Prolapse... 2—-. (2... :. b._¢) -_2S ee 185 
I. Hernia 22020 ee ed ee 185 
TL. -iProlapse._-2 2.222. 6. Se 2s ee 188 
Diseases of Bones-_.-- 2-22... eee 190 
1. Practures 2-9) oles eo Soo es te 190 
II. Inflammation of Bone. Periostitis. Ostitis. Osteomyelitis 216 
1. Inflammation of the Periosteum. Periostitis_________ 217 
2. Inflammation of the Bone Substance. Ostitis________ 220 
3. Inflammation of the Bone Marrow. Osteomyelitis_._.. 221 
III. Necrosis, Atrophy, and Hypertrophy of the Bones________ 226 
1. Necrosis of the Bones2i2322.00 es ee 226 
2... Atrophy of the Bones i yi.7 2) ee 228 
3. Hypertrophy-of the Bones 2 27 eee 229 
TV2 Rachitis and Osteomalacia_ 24 220-0 2 eee 229 
Diseases of Joints... _.=-5-2¢ 2232 oe eee cee 232 
I. Inflammation of the Joints. Arthritis or Synovitis______- 233 
1. Serous Inflammation. Arthritis Serosa_________----_- 234 
2. Suppurative Inflammation. Arthritis Purulenta___... 236 


3. Deforming Inflammation, Arthritis Deformans___-_- 238 


CONTENTS XIII 


4. Tubercular Inflammation. Arthritis Granulosa______- 243 
Il. Changes in Position of the Joints. Luxation, Distorsion, 

Cate Pg Ua Week gh dG BLE Cope I ER LMS Scape ns 6 EVE ly WL ste ae 247 
femictsation.ors Litslocastion. <2 a woh er ea ee ee 247 

mm PIS COTRIONT OF ODISiN cee eet A es SE. 252 

eeu Contusion.or Bruise ofthe foint 2-2. Jooe eee 253 

Mime Cnciy losis amd Contracttre 202 ee es te 254 
See TICIY LOSIS, Or stl tess 2. ew eae aoe oe et 254 

Pere olny. COUutactnres (OLittb OO). ns aiues ce ate ns SA 256 

Bree ont. Bodies. eCorpora Libera. Cs S08 oe 258 


Diseases of the Tendons, Tendon-Sheaths, and Mucous Bursae__-_ 259 


MeeeLiscases Oli tive: 1 Eidos 2.2 es es a a 264 
1. Inflammation of the Tendons. Tendinitis___________- 264 

PROP CHULO TLIC UTS vee ea ety eee. Ae ee Ome ot eee 267 

Bee PCNIUONUNE CEOS Syrah tal ee Ctl ee Ot Ee 270 
femebiceases ol, Lendon-pheaths (42 2 fe eae ke oY fe 
1. Inflammation of Tendon-Sheaths. Tendo-Vaginitis__ 272 
2. Distension of Tendon-Sheaths. Hydrops____--______ 275 

Pires Lisenses of Mucous Bursaee eG er i ee 278 
t. Inflammation of Mucous Bursae. Bursitis_______:____ 278 

Mme VETOmMes Ors MaCOUS BUTSAGL] 2 US Soa abs 8 a 280 
Diseases of the Muscles, Fasciae and Nerves--__--_-_-------------- 283 
Dane iceascesaratwenyruseles = 2 SU es i ee 283 
col nnammetiorm of, Muscles...) Myositis: 2.02 286 

emmy) Limes eM PENie he nl ki ev ee 293 
es TENS eG) 5 0, Sa i ee 295 

Vole eg PS TS iy 1 ERS Shee iy 2S 0 aaa a ee ec 297 
eam eCCrOabme erasel = fk 58 So 297 

Buemeis OL renO Mm MeN asC tee: 2 oe oe ee 298 

Pile IScdses Ol@Neiver a. oo OL ed ee be 299 
femeeates unset ArALy Sigh wh oe ip A 299 

ae iithanination-of Nerves, Netiritis 5.0 "cbic ook 302 
MPR SESTOLIN CGSC1S 45 20th 2. ee ae 305 
Pa meascecoiuArterteg. 20) Ames 2  e  e ee 305 
Pominiagmmationvo: Arteries, /Arteritics at 2559 305 
peeiititation of Arteries, (A tientyeni) Poca eee ts ee 306 

BIR MDL arenaleLarveaATtenes oa 771. a use mae lee Fe Nook rd 
IMENEIGCASCE SOLO ViCITIS 2 Sst ey re a ee er ee kel ue: 
Meeliutinimeation of, veins, VP hiebitis2 oe ae cae 

2.) Dilitation oipV eins: 7 yVarix., .Phlebectasis ou. 1. 314 
piumumiiseases Of; Lyinph-Vessels. ool ee ye eh 316 


XIV CONTENTS 


1. Inflasnmation of Lymph-N essels-3 7.07 2 ee eee 316 

2. Dilitation of Lymph-Vessels. Lymphangiectasis_____ 317 
Diseases. of Glands... 2 2- se Ue ee 319 
I. Inflammation of Lymph-Glands. Lymphadenitis________ 318 

II. Inflammation of the Mammary Glands. Mastitis________- 320 
Surgical Diseases of the Skin and Mucous Membranes__.-__---___ 328 
I. Surgical Diseases of the Skin 2727s eee 423 

1. Inflammation of the Skin: Dermatitiss{< 723 323 

2, Burns.) : Combustio 2.6 2 4 sae 325 

a, Freezing. Cougelatiou. 27 eo a 328 

II. Surgical Diseases of the Subcutaneous Tissue____________ 330 
t.Hdema, Uete ot oe ee 330 

2. emphysema. eo See a ee ee aay 

III. Surgical Diseases of the Mucous Membranes____________- 432 
IV. Surgical Diseases of the Pododerm __-_u) =e. eae sa3 
Appendix. Congenital Malformations of Surgical Importance_____ 334 
Index ..--2522 ees -o oop eas oss ee 339 


<hee 


WOUNDS 


I GENERAL REMARKS CONCERNING THE NA- 
TURE, SYMPTOMS, AND CLASSIFICATION 
OF WOUNDS. 


DEFINITION.—A wound, in a restricted sense, indicates 
any injury accompanied by a breach in the continuity of the 
skin or mucous membrane. Wounds may also be defined as 
open, hemorrhagic injuries, in contrast to lacerations and 
fractures which occur in the subcutaneous tissues and are not 
characterized by a breach in the continuity of the outer cov- 
ering. ‘The latter are closed to the presence of air, they are 
aseptic; that is, protected against the entrance of infectious 
irritants. Wounds, on the other hand, are open to the entrance 
of septic infection. The symptoms, course, prognosis, and 
treatment for both are, therefore, extremely variable. For 
this reason the open and subcutaneous injuries must be 
considered under separate headings. 

An ulcer is differentiated from a wound by its tardiness in 
healing ; it may be considered as a wound which will not heal. 

GENERAL SYMPTOMS OF WOUNDS. The most important 
symptoms of fresh wounds are hemorrhage, pain, 
gaping, and disturbed function. 

1. Hemorrhage varies according to the size and con- 
dition of the wounded vessels. One recognizes arterial, venous, 
parenchymatous, and capiliary hemorrhage. Arterial hem- 
orrhage is that which results from injuries to individual 
arteries, it spurts from the wound and is bright redincolor. In 
venous hemorrhage large veins are involved, dark red blood 
flows from the peripheral ends in a continual stream as from 
a spring. Parenchymatous hemorrhage includes both 


4 WOUNDS 


arterial and venous (mixed hemorrhage) ; the incised vessels 
are small, the blood is medium-red in color and flows from 
all portions of the wound similar to being squeezed from a 
sponge (tumors, swollen parts, muscle). Capillary hemor- 
thage follows slight injuries to the skin and mucous mem- 
brane, the blood flows in drops from the incised capillaries. 
As a rule, transverse wounds to vessels bleed more freely 
than those in a longitudinal direction because the gaping is 
greater (therefore an incision should be longitudinal when 
operating). In contused wounds the hemorrhage is occasion- 
ally very slight, the adventia constricts, the intima and 
media are retracted inwards, this results in mechanical closure 
of the vessel similar to that which occurs in torsion (ecraseur, 
emasculator). Penetrating wounds of large vessels usually 
close spontaneously (penetrating injury of the jugular from 
intravenous injection, an occasional penetrating injury to the 
carotid during the same operation). In previous anastomosis 
formation vessels bleed from both ends (carotid, large veins, 
thyroid gland). 

_ ‘The following symptoms are observed after severe hem- 
orrhage: general anaemia which is especially characterized by 
paleness of the visible mucous membranes ; coolness of the 
skin ; as well as weak pulse and heart-beat which results from 
sinking of the blood pressure and weakness of the heart. 
Death from hemorrhage is further preceded by general weak- 
ness, tottering, vertigo, loss of consciousness, dyspnoea, dili- 
tation of the pupils, disappearance of the corneal reflex action, 
involuntary urination and defecation, as well as convulsions. 
Death is more certain when the loss of bloodis 
more than a third of the total amount. ‘The 
The total amount of blood in a horse is equal to about one 
fifteenth of the total body weight. A horse weighing 450 kg., 
for example, (blood contents = 1/15 = 30 kg. or litres) dies 
after a loss of more than 10 kg. (litres) of blood. Loss ofa 
third of the blood is followed by pronounced heart weakness 
and sinking of blood pressure, it is possible, however, for 
regeneration of the blood to take place from the parenchyma- 
tous fluids. Loss of a fourth of the total amount of blood is 


WOUNDS 3 


only followed by decreased blood pressure (phlebotomy). 
Regeneration occurs through the absorption of water from the 
lymph of the tissues as well as from the fluid contents of the 
stomach and intestines (hydraemia); this is followed by an 
increase in the formation of the white blood corpuscles (leuco- 
cytosis); finally the red blood corpuscles gradually increase 
in number. 


Injuries to large lymph vessels, joints, and tendon sheaths 
result in a discharge from the wound of lymph, synovia, 
and tendon-sheath fluid respectively ; saliva is dis- 
charged from wounds to the salivary glands, salivary ducts, and 
esophagus ; food or feces from perforating injuries to the 
stomach or intestines; milk from wounds to the udder; 
urine from lesions to the bladder or urethra. Hemorrhage 
is absent in corneal wounds. 


2. Pain is due to cutting, bruising, or tearing the sen- 
sitive nerves. ‘The so-called primary pain should be distin- 
guished from secondary wound pain due to inflammation 
(nailing!). The pain of wounds is in direct proportion to the 
nerve supply of the affected tissues. Wounds of the skin, 
pododerm, periosteum, mucous membranes, cornea, or peri- 
pheral nerve endings are more painful than those of bone, car- 
tilage and tendon, connective-tissue, or brain substance. ‘The 
blunter the cutting instrument, and the slower the separation 
of the tissue, the greater the apparent pain (experience in opera- 
tions). The sensitiveness of different animals 
varies according to the individual, age and sex, as well as 
the race and species. Many horses are very sensitive to 
neurectomy while others remain quiet during the operation. 
Many horses will stand without narcosis for trepanation and tra- 
cheotomy, as well as similar operations which require restraint, 
while others must be cast and restrained for operations that 
are far less painful. In general horses are more sensitive than 
cattle ; dogsand cats more than horses. Horses that belong to 
the warm blooded races frequently show more sensitiveness 
than those of the cold blooded race (e. g. castration). Mares 
and stallions are usually more sensitive than geldings. The 


4 WOUNDS | 


following appear least sensitive : old horses, phlegmatic horses, 
and those affected with blind staggers. 

In comparison to man, all domestic animals appear to be 
less sensitive to wounds. Many animals, after a severe in- 
jury, show a certain amount of resignation similar to man 
(trained dogs). 

Complete insensibility follows deep narcosis (chlo- 
roform, cocaine); is present in dead tissues; and occurs after 
neurectomy, so that nail puncture in the hoof, for example, 
does not cause pain. 

3. Gaping of wounds depends on the character of the 
incised tissue, as well as upon the direction of the wound. 
Gaping is most pronounced in those places where the skin is © 
widely separated as a result of transverse muscle and tendon 
wounds. 

4. Disturbed function occurs after wounds of the 
hoof, tendons, joints, and muscles, where it is characterized by 
lameness ; wounds of the tongue result in deranged mastica- 
tion; blindness may follow corneal wounds; wounds to the 
motor or sensory nerves may produce paralysis or anesthesia. 

Very painful wounds in the horse result in a diminution 
or complete loss of appetite, this is frequently observed 
after horses have been operated under restraint. Genuine 
shock or wound shock (sudden paralysis of the vasomotor cen- 
ter with anemia of the mucous membranes, retardation and 
paralysis of the activity of the heart) is very rare in animals. 
Perforating abdominal wounds in the horse are frequently fol- 
lowed by colic (peritonitis). The following conditions fre- 
quently follow injuries to large nerve branches (neurectomy): 
stagnation edema, inflammatory conditions, ulcer formation 
and necrosis of the skin and pododerm, inflammation of the 
periosteum, bone, and joints, exungulation, atrophic changes, 
fractures, tendon ruptures, etc. (See chapter on diseases of the 
nerves.) Occasionally sudden death follows the introduction 
of air into the jugular vein (operation on shoulder abscess, 
phlebotomy); this is partly due to paralysis of the lungs (air 
emboli in the pulmonary capillaries), partly to paralysis of 
the heart (air in the chambers of the heart, air emboli in the 


WOUNDS 5 


coronary arteries), partly to paralysis of the brain (air em- 
boli in the capillaries of the brain). The aspiration of air 
into the abdominal cavity (gurgling sound), sometimes ob- 
served in the castration of stallions, is usually harmless. 
Finally, any wound may be followed by wound fever. ‘Two 
forms are recognized, aseptic and septic wound fever. Aseptic 
fever is due to the resorption of degenerated blood products 
without the presence of bacteria. It is characterized by a 
slight elevation of temperature without severe disturbances 
of the general system (see chapter on wound fever). Septic 
fever, on the other hand, depends on the presence of specific 
infectious material which gains entrance to the wound and 
finally enters the blood stream. It is characterized by a 
marked elevation of temperature and severe derangement of 
the general system (see chapter on septicaemia and pyaemia). 


CLASSIFICATION OF WouNnpbs.—According to the causes 
wounds are classified as follows: incised, punctured, 
lacerated, contused,stab, shot wounds, and bites. 
In addition to wounds due to mechanical force one must con- 
sider injuries produced by chemical irritants (caustics), and 
thermic influences (burns, freezing), which are classified as 
caustic wounds, necrotic wounds, etc. 


According to the condition of the wound they are 
classified as simple or non-contused (incised, punc- 
tured), and complicated or contused wounds (con- 
tusions, shot wounds, bites), wounds with and without 
loss of substance, flap or skin wounds, clean, 
unclean, (hair, dirt, dust), infected and poisoned, 
Superficial, deep, and perforating or penetrat- 
ing (abdominal cavity, thorax, joints), slight, severe, 
and fatal, fresh and old, hemorrhagic, suppura- 
tive, granulating and cicatrized wounds. 


According to the seat and tissues involved they are 
classified as wounds of the head, thorax, throat, ab- 
domen, skin, mucous membranes, muscles, 
bones, cartilage, joints, tendons, brain, cor- 
nea, stomach and intestines. 


6 INCISED AND STAB WOUNDS 


SHOCK IN ANIMALS.—Beck has observed one case of paralysis of 
the heart in acalf asa result of castration (Wochenschrift fir Tier 
heilkunde. 1901). The animal bellowed very loud after the remova- 
of the first testicle (pain, fear, terror), collapsed and died immediately. 
The results of a post mortem were negative. 


II. INCISED, PUNCTURED, CONTUSED, SHOT, 
LACERATED AND POISONED WOUNDS. 


INCISED AND STAB WouNnps.—These are due to injur- 
ies from surgical and ordinary knives, hay knives, hoof knives, 
butcher knives, case knives, shears, glass, pieces of iron, 
scythes, sickles, sabers, hatchets, etc. The characteristics. 
of incised and thrust wounds consist in their straight dir- 
ection, longitudinal form, as wellas sharply de- 
fined, smooth, non-contused edges. Hemorrhage 
and retraction of edges are more pronounced than in the other 
forms. ‘They are most often seen in horses, dogs, and cattle 
‘on various parts of the body, especially the limbs. According 
to depth they may be termed wounds of the skin, muscle, 
tendon, bones, and perforating wounds. The prognosis is 
‘favourable when the skin only is involved (suture). Froma 
forensic standpoint it should be observed that many lacerat- 
ed and contused wounds present edges similar to those of in- 
cised wounds (wire, sharp edge of the hoof). 

PUNCTURED WouNnpbs.—Punctured wounds are caused by 
manure forks, hay forks, nails, needles, pointed knives, and 
shears, lances, bayonets, harrows, splinters of wood, etc. 
Penetrating wounds in horses are most often due to manure 
and hay forks, as well as treads on nails and nailing. In the 
German Army the lance is a frequent cause of wounds on ac- 
count of its wide use in the cavalry. During operations. 
punctured wounds are often produced by means of the injection 
needle and the trochar (subcutaneous, intravenous, intra- 
peritoneal, parenchymatous, intraocular, subconjunctival, sub- 
dural, intracranial, and even intracerebral injections, paracen- 
tesis thoracis, paracentesis, abdominis, harpooning the udder, 


BITES, LACERATED AND CONTUSED WOUNDS 7 


lumbar puncture). Punctured wounds are usually smal], 
round, slightly hemorrhagic, and frequently leadtoa 
fistulous canal. Perforations into joints, tendon sheaths, 
abdomen, thorax, eyes, etc., are common. Experience with 
injections and puncture has demonstrated that perforating 
wounds with sharp, clean instruments are harmless when they 
penetrate body cavities, the rumen, intestines, or a large 
blood vessel (jugular, carotid). All unclean objects, however, 
especially manure forks, unclean injection needles, old nails 
and harrow teeth, are liable to result in suppurative and septic 
infection (phlegmon, abscess, fistula formation, septicaemia, 
malignant edema, tetanus). Punctured wounds of the hoof 
(treading on nails, nailing) are frequently followed by tetanus. 


CoONTUSED WouNbDs.—Contused wounds are injuries caus- 
ed by blunt objects, treads on the coronet, kicks, falls, col- 
lisions, running into objects, being run over, falling into holes, 
remaining in a recumbent position for a long time. Con- 
tused wounds are usually irregular in outline, possess 
jagged, unclean margins, areswollen, often havea 
loss of substance, andthe contused tissue has a tend- 
ency to become necrosed. Occasionally hemorrhage is 
slight or fails entirely even in large contused wounds. One 
can differentiate superficial (excoriations, abrasions of the 
skin) and deep contusions, with and without loss of substance. 
(See chapter on contusions. ) 

LACERATED WouNDsS.—Lacerated wounds have some of 
the characteristics of incised wounds, they are also similar to 
contused wounds. ‘They are caused by catching on or getting 
against hooks and nails, by sharp calks, running into wagons, 
machinery, etc. In horses they are most often seen on the © 
head (false nostril, eyelid), on the thorax, buttocks, and pos- 
terior limbs. Special lacerated wounds are observed on the 
cornea in dogs (scratches from cats). Lacérated wounds are 
frequently in the form of flap wounds with angular forma- 
tions, the margins of the wound may be regular or torn. 

Birkes.—Injuries caused by bites from dogs, horses and 
other animals present various characteristics; they may be 
punctured, contused or lacerated. They most frequently 


8 POISONED AND GUN SHOT WOUNDS 


occur in dogs and horses, seldom in cattle or other animals. 
Dog bites frequently result in severe phlegmon and com- 
plicated bone fractures; bites from horses in extensive 
necrosis of the skin on the sides and top of the neck (bites 
from animals standing in the same stall at night. ) 

POISONED Wounps.—Under this term are included 
injuries, especially to animals at pasture and hunting dogs, 
due to snake bites, bee and wasp stings, as well as infected 
wounds (rabies, anthrax, glanders, tetanus, septicaemia). 
With reference to the specific diseases thus produced one must 
consult text books on toxicology and infection (see chapter on 
wound infection diseases). 

SHOT WouNpbs.—These belong to a special type of con- 
tused wounds and may be termed contused-lacerated wounds. 
They are characterized by an external opening with smooth, 
contused, angular or lacerated margins, a tubular shot canal, 
and an exit opening. When the latter fails it is termed a 
blind shot canal. When the shot is fired near the seat of in- 
jury the wound edges are burned. Superficial, long, gutter- 
shaped injuries of the skin are observed in furrowed gun- 
shot wounds, contusions of the subcutaneous tissues without 
injury to the skin in gunshot contusions. Shots which per- 
forate only beneath the skin are termed seton shots. In the 
bones there exists either a shot hole, that is, a round, somewhat 
tube-shaped shot wound without splintering of the bones, or 
comminuted fractures, that is, comminuted bone frac- 
tures with splintering and crushing of the bones ; gun-shot con- 
tusions may be characterized by subcutaneous (simple) frac- 
tures. Unfortunately the literature of the German veterinary 
surgeries concerning gun shot wounds of horses in the earlier 
campaigns is worthless. According to the statistics of Jewse- 
jenko collected in the Russo-Turkish War, from a total of 211 
horses shot, 41 involved injuries of the bone (equal to 20 per 
cent). Healing frequently follows encapsulation, especially 
small shot, the latter seldom change position (wandering). 
When other bodies, however, enter with the bullet; namely, 
dirt, hair, portions of the covering, of the tugs, etc., there 
develops a suppurative or ichoric inflammation in the vicinity 


GUN SHOT WOUNDS 9 


of the shot canal. Shot woundsin horses are of importance in 
war ; otherwise they are seldom observed (hunting dogs, cats). 


GUNS AND PROJECTILES.—Shot injuries are produced, either by 
hand weapons (muskets, revolvers, pistols, small rifles), or cannon 
(shells, schrapnel, solid shot). Injuries caused by small shot are rela- 
tively slight, experience has demonstrated that in dogs they may heal 
without reaction. Injuries caused by musket balls are of more impor- 
tance. While these balls were formerly manufactured from lead, were 
round, and tolerably large in diameter, the bullets of modern weapons 
of war, especially the eight millimeter gun, have a very small diameter 
(eight millimeters), a cylindrical, long form, as well as a very hard 
steel jacket over a core of lead. On account of the steel jacket and 
small diameter these bullets retain their form, while the earlier bullets 
were flattened or shattered when they came in contact with a bone, 
causing severe injuries, especially to the soft tissues. Modern pro- 
jectiles exert, however, on hard bodies, especially 
bone, more active splintering force, and in addition to 
this an enormous penetration. 

According to Kocher (Zur Lehre von den Schusswunden durch 
Kleincalibergeschosse. 1895) the force of modern projectiles is a blow in 
the direction of their flight(penetrating influence)on theoneside, 
and an explosive effect (lateral impaction) onthe other. Asaresult 
of the penetrating as well as the explosive effect the tissues involved 
are either lacerated or contused (explosive effect), or torn away (pene- 
trating force). The slower the speed of the bullet, the lighter the 
explosive effect; penetration and explosive effect stand, 
therefore, in an inverse ratio to each other. If the pro- 
jection force is less than the cohesion strength of the involved parts 
they become stretched and contused ; when both are equal there exists 
a wedge-shaped perforation ; if the force of the shot is greater than the 
cohesion of the parts the tissues are ruptured. In the first case the 
involved tissues are stretched; in the second they are pushed forward 
or to one side; in the third, lacerated. The degree of rupture 
depends on the diameter of the shot and the character of the tissues. 
An increase in the diameter of the missile is constantly occurring, this 
increases the surface of contact (oblique exit, change in the form of 
feeenior. there exists a “reciprocal” influence between 
the target and the shot, in which the increased resist- 
ance of the target increases the explosive effect of the 
bullet, the explosive effect is also intensified by increasing the speed 
of the bullet. With increased resistance and explosive force there is a 
parallel diminution in the speed of the bullet (heating, deformation). A 
decrease in calibre and increase in the strength of the 
jacket results in decreased explosive force for elastic 
bodies, muscle and epiphyses of bone. Small calibre shots 


IO GUN SHOT WOUNDS 


from a short distance produce the following effect on cortical bone : 
laceration and contusion, splintering, and a bullet-shaped enlargement 
of the exit wound ; large calibers produce very severe lacerations with 
enlargement of the entrance wound; with an increased velocity small 
bullets may produce the same results. Through international agreement 
a calibre of not more than six millimeters has been adopted, the bullets. 
to be covered with a hard jacket, so that they do not become deformed 
by spreading, lacerations are prevented as much as possible and the 
prognosis from shot injuries very much improved. 


The effect of the German eight millimeter gun on men and animals. 
has been demonstrated by experimental investigations (Preussisches: 
Kriegsministerium, v. Bruns, Kocher, Kohler and others). According 
to the investigations of Ellenberger and Baum (Berliner Archiv. 1893) 
on the horse it has a very variable action on different parts of the body 
at a distance of 250 to 600 meters. 

1. The skin had, as a rule, a smooth-margined entrance wound 
which was usually smaller than the diameter of the bullet. The exit 
wound in the skin was always larger than the entrance 
wound. It was especially large when the shot had penetrated bones 
and the wound was torn by bone splinters. 

2. Injuriesto muscle vary according to their thickness. Insmooth, 


stretched muscle the wounds are in the form of a slit, have smooth edges. 
and are smaller than the diameter of the bullet; those in thick muscles. 
are larger and more lacerated. The track of the bullet gradn- 
ally enlarges, thereby increasing the laceration so that 
the exit wound is about double the size of the entrance 
wound and severely lacerated. Spent bullets (rebounding 
shots), as well as bullets which have passed through bone, produce 
severe tearing of the muscles. It is remarkable that in such cases. 
vessels and nerves sometimes remain intact. Wounds in the fascia and 
connective tissue are in the form of aslit, frequently they are recognized 
with difficulty. Tendons are split with a slight retraction of the edges. 

3. The epiphyses of the long bones frequently pre- 
sent a shot hole, extensive laceration is constant; the 
epiphysis is less frequently disunited. Shots in the diaphyses, on 
the other hand, are usually characterized by complete 
fracture, or at least accompanied by pronounced splin- 
tering; even with grazing shots the bones, asa rule, are completely 
comminuted. Grazing shotson the epiphyses lead to splintering. Shots 
in the center of short bones (carpus, tarsus, vertebrae) usually 
result in comminution. Flat bones usually present a 
shot hole with a round, small entrance wound, and a larger wound 
of exit which produces fissures and slightsplintering. When the 
ribs are hit in the middle there exists a shot hole the size of.the bullet’s 
diameter, with longitudinal laceration and slight splintering at the 


GUN SHOT WOUNDS II 


somewhat enlarged wound of exit. Grazing shots in the longitudinal 
direction of the body fracture the ribs. Transverse shots 
through the thorax penetrate the entire horse. When 
the bullet comes in contact with a rib at the entrance wound, one is also 
fractured at the wound of exit, it is a complete break in the continuity. 
On the bones of the skull there is produced a shot hole 
with splintering and sometimes crushing of the bones. 
The base of the skull is shattered. Gunshot wounds of the cartilage, 
on the other hand, are relatively small, they are often in the form ofa 
smooth split. 


4. The lungs are severely lacerated, the shot track usually contains 
splinters of bone, near the wound of exit the track increases in diameter. 
Also in the heart, one finds lacerated, flap, gaping wounds ; seldom small 
round openings. In the small intestines there usually exists a small 
shot hole; in the large intestines, on the other hand,the wound is 
usually broad, flap-like and lacerated. 

The French Weapons, according to Gabeau (Recueil vét. 1895) in 
experiments on the cadaver of the horse, result in severe injuries which 
are always of a complicated nature. At a distance of 100 to 200 
meters all bullets penetrated the body of the horse. 
In the skin the entrance wounds are circular, as though penetrated with 
a punch; the skin itself is not changed. In soft parts the exit wound 
is oval in form; skin overlying bones on the other hand, is lacerated 
and notched. In muscles the wound canal is much larger 
than the diameter of the bullet; it contains fleshy, bloody 
masses atid dilates in the direction of the exit wound. The muscle 
fibers appear to be torn in the direction of the rotation of the bullet. 
The aponeuroses and flat ligaments present Mnear wounds; tendon 
wounds are twice the width of the bullet, their fibersappearto be tornand 
lacerated. Long bones are broken or split and present oblique frac- 
tures with extensive splintering ; short bones are crushed into splinters ; 
the ribs present transverse fractures. The joints are commin- 
uted, their bones are crushed to pulp; sometimes 
fragments of the bone are torn away and thrown sev- 
eral meters. The exit wound of joint shots is very large, the skin 
is torn in shreds. The lungs have cylindrical shot canals. In the 
liver the entrance wound is much larger than the ‘bullet, the wound 
canal is very wide, the tissue of the liver is ground to pulp fora distance 
of three or four centimeters. In the stomach and intestines 
the entrance and exit wound are seemingly equal in size. In the 
hoof the entrance wound is hardly one mm. in diameter, almost 
invisible ; the penetration of the hoof is complete. 

The explosive effects of the so-called dum dum bullets is extremely 
active. These are small caliber bullets from which the steel point has 
been removed (expansive bullets). According to Walker (The Veter- 


12 ARREST OF HEMORRHAGE 


inarian. 1899) the entrance and exit wounds are small; the shot expands 
in the tissues and lacerates the bones and soft tissues. 


TII. ARREST OF HEMORRHAGE. 


SPONTANEOUS ARREST OF HEMORRHAGH.—This is a 
cessation of hemorrhage of itself in contrast to artificial arrest 
by means of therapeutic agents. The so-called ‘‘ stopping ’”’ 
of hemorrhage occurs in capillary and parenchymatous hem- 
orrhage, as well as from that due to injuries to small arteries 
and veins. 

The causes of spontaneous arrest of hemorrhage are, first © 
of all, the small amount of blood, in addition one finds 
a retraction of the vascular walls with a narrow- 
ing of the lumina of the vessels. Coagulation of the exposed 
blood results in the formation of a thrombus which closes the 
opening and lies partly within the lumen of the blood 
vessel. Because of slight blood pressure in the capillaries and 
veins thrombi form in them in a very short time, thus arresting 
hemorrhage. In large vessels, on the other hand, especially 
in arteries, thrombus formation fails to occur, or exists only 
after the loss of a large amount of blood with resulting heart 
weakness and decrease of blood pressure, so that the blood 
coagulum is no longer forced away by the blood stream. 
After the loss of large quantities of blood it is made more 
coagulable by the addition of white blood corpuscles, thus aid- 
ing in the arrest of hemorrhage: ‘This explains, for example, 
a fact which has been demonstrated by experiment, that stal- 
lions castrated without any precautions finally recover after 
severe hemorrhage. In general, as already remarked, the 
loss of blood must not exceed a third of the total amount, oth- 
erwise, there occurs a fatal paralysis of the heart and brain. 
Quantitative regeneration of the blood seems to take place 
rapidly through resorption of lymph from the tissues, as well 
as fluids from the stomach and intestines. The newly formed 
blood is, however, at first, very rich in water, the red blood 
corpuscles, on the other hand, are deficient, they are formed | 
only after a long time. 


ARREST OF HEMORRHAGE ia 


The exact phenomena of thrombus formation are 
not fully understood. The principal factor in arrest of hem- 
orrhage is the formation of a so-called white thrombus, 
which is composed of white blood corpuscles and the blood 
plates discovered by Bizzozero. This must be differentiated 
from the fibrinous coagulum which is the ordinary pro- 
duct of coagulation within the cadaver or outside the body. 
In contrast to the white thrombi, which to a certain extent are 
the result of physiological processes in normal living bodies, 
the so-called red thrombi are formed asa pathological pro- 
cess. The latter are made up of red blood corpuscles and fibrin 
and are formed during life in the vessels of animals suffering 
from septic affections, as well as from a general marasmus 
(marasmatic thrombi). These red thrombi are formed by a 
process of coagulation and death, similar to the formation of 
blood coagula in cadavers, they possess, therefore, an essen- 
tially different composition and importance. When both white 


and red thrombi exist at the same time they are termed a 
mixed thrombi. 


The course of white thrombi varies according to 
the presence or absence of infectious material. When the throm- 
bus remains free from infection, so-called organization 
occurs ; that is, it develops into indurated, vascular, connective 
tissue, whereby the injured vessel contains a solid and perma- 
nent cicatricial obstruction. If infectious material gains en- 
trance to the thrombus, however, there occurs a suppurative and 
ichoric softening of the thrombus with subsequent emboli. 


1. The so-called organization of the thrombus con- 
sists in a replacement of the same by connective tissue. The 
cells of the thrombus itself do not undergo active division, the 
thrombus plays more of a passive role in that it is gradually 
pushed away by the newly formed tissue. The new con- 
nective tissueis produced by proliferation of 
the vascular epithelium. The endothelial cellsof the 
intima of the vessels proliferate and are transformed into 
spindle-shaped and polymorphous formative cells, which 
advance towards the center of the thrombus, they penetrate 
and surround the same and are transformed later into fibrillar 


14 ARREST OF HEMORRHAGE 


connective-tissue cells; so that the thrombus, under the influ- 
ence of the firm connective tissue, is finally pressed away and 
replaced. Vascularization of the thrombus oc- 
curs at the same time by means of a budding 
process from the vasa vasorum. In about four 
weeks the thrombus, when formed in small vessels, is made up 
of a cicatricial mass of connective tissue penetrated by capil- 
laries ; subsequently this becomes harder as a result of atrophy 
and retraction of the capillaries. Calcification or cretefaction 
of the thrombus is rare (so-called vein-stone or phlebolith). 

The re-establishment of the circulation, which was broken 
by the thrombus, is made possible by the formation of a 
collateral circulation, in which the central and per- 
ipheral branches of the artery given off at the thrombus, as 
well as the vasa vasorum, are dilated. Occasionally the blood 
stream afterwards passes through the center of the thrombus, 
which becomes pervious; or it may pass through dilated 
cicatricial vessels. . 

2. Softening of the thrombus is due to the entrance of 
bacteria, which produce a suppurative liquefaction and ichoric 
disintegration of the thrombic mass and thereby the danger of 
embolic processes and general infection of the body (compare 
with the chapter on pyaemia and phlebitis). 

DETERMINATION OF THE AGE OF A THROMBUS.—This is of impor- 
tance to the veterinarian from a forensic standpoint (thrombus of the 
arteries of the limbs and pelvis in the horse). Unfortunately, exact 
experimental investigations on the horse are wanting. In general 
thrombus formation is more rapid in small vessels than in large; pro- 
ceeds more rapidly in young animals than in old. Thrombus formation 
in chronic endarteritis in the horse seems to take place especially slow. 
In dogsit has been demonstrated experimentally that the thrombus is 
vascularized in from seven to fourteen days after injuries to small ves- 
sels, it is also composed of soft tissues; after three to five weeksa 
complete vascular cicatrix is present. Occasionally organization of the 
thrombus requires a much longer time. In old age calcified thrombi 
are observed. In general the age is determined by the consistence and 
color of the thrombus, which finally becomes hard and clear, as well as 
by the changes in the vascular walls. 

ARTIFICIAL CONTROL OF HEMORRHAGE.—This consists 
of closure of the bleeding vessel either by means of pressure or 


ARREST OF HEMORRHAGE 5 


coagulation. The following are the most important methods: 
1. Ligation of the bleeding vessel. The ligature is 
the surest means of controlling hemorrhage from large arteries 
and veins. The bleeding vessel is grasped with a good ‘pin- 
cette and then ligated with silk. When the isolation is not 
complete the surrounding tissue is also included (ligature en 
masse) after having passed around the parts with a needle. 
If none of these methods are applicable on account of the 
depth of the bleeding vessel the spurting artery must be ligated 
at a centripetal point (ligation in the continuity), for example, 
the carotid is ligated after an injury to the internal carotid. 


2. Compression of vessels by knots and band- 
ages is indicated in capillary and parenchymatous hemor- 
rhage. Occasionally strong pressure may be brought to bear 
on the bleeding vessel by means of a tampon in the wound. 
Momentary and provisional relief from hemorrhage may be at- 
tained through pressure with the finger or hand (digital 
compression), the application of an elastic bandage (Es- 
march’s bandage), or a rubber bandage (Martin’s 
bandage); pressure should be applied between the wound 
and the heart. A special method employed by the veterina- 
rian for the control of hemorrhage consists in the application 
of clamps for the castrationof stallions. The formerly em- 
ployed tourniquets (pad in the form of a girth) as well 
as the so-called acupressure are very seldom used at the 
present time. 


3. Torsion of the bleeding vessels results in loosening 
and rolling up of the intima and media, as well as retraction 
of the adventia, thus closing the lumen of the injured vessel. 
Torsion is either applied to the bleeding vessel alone, when it 
is grasped with the pincette and twisted on its axis for a long 
time, or the surrounding soft tissues may be included (torsion 
of the spermatic cord). From many castrations of horses I am 
convinced that regular torsion of the spermatic cord is a surer 
means for the prevention of hemorrhage than either clamps or 
the ligature; from a standpoint of simplicity or asepsis torsion 
and clamps, especially the latter, are not preferable. 


~ 


16 ARREST OF HEMORRHAGE 


4. Heat in the form of a red hot iron or cautery is effhi- 
cient in many formsof parenchymatous hemorrhage. It forms 
an eschar over the ends of the bleeding vessels which performs 
the’ function of an aseptic bandage (searing the tail after 
amputation). The application of cold (ice-cold water, spray 
of ether) is less effective. Its action is due to the contraction 
and narrowing of small vessels. Hot water is employed 
at a temperature of 45-50 C. asa styptic for parenchymatous 
hemorrhage of the uterus. Hven steam at a temperature of 
100-120° has been employed recently in the human family for 
persistent cases of uterine hemorrhage (vaporization of the 
uterus, so-called atmocausis and zestocausis). 

5. Thefollowing therapeutic agents exertastyp- © 
tic influence, active only in capillary and parenchymatous 
hemorrage: liquor ferri chloridi, concentrated or com- 
bined with collodion, with surgeons cotton or in aqueous 
solution. This causes coagulation of the blood with simul- 
taneous constriction of the blood vessels. Other agents are 
alum, tannin, creolin, sugar of lead, nitrate of silver, oil of 
turpentine, gelatine (subcutaneous), ergot or hydrastis 
is employed to control hemorrhage that cannot be treated 
surgically. 

HEMOPHILIA.—Hemophilia (blood disease ) isa congenital tendency 
to hemorrhage (hemorrhagic diathesis) which presents the following 
characteristics in man: uncontrollable hemorrhage after 
very slight wounds. This disease also occurs in the horse (K6hne, 
Siedamgrotzky, Dreymann, Otto, Zschokke, and others). The following 
examples have been observed: after enlarging castration wounds, after 
the removal of setons, after splitting fistulous canals, after the extraction 
of teeth in dogs; hemorrhage has continued for hours and days regard- 
less of all preventatives. Not all reported observations from veterinary 
_ sources are free from exception ; I have never seen a case of hemophilia 

in the dog or horse. The real cause is unknown (abnormal condition 
of the blood? failure to coagulate ? deranged nourishment of the vas- 
cular walls?). According to Schindelka many descendants of the thor- 
oughbred stallion ‘‘Gunnersbury’’ suffer from a hemorrhagic diatheses 
(epistaxis) (transmission as in man ?). 


KINDS OF WOUND HEALING 17 
IV. ANATOMICAL CHANGES IN WOUND HEALING. 


KINDS OF WouND HEALING.—The anatomical changes 
in the healing of wounds, which have been demonstrated by 
the exhaustive investigations of Thiersch, are extremely 
variable. They depend upon the following conditions : whether 
the wound is clean or infected, sutured or open, incised or 
contused, with or without loss of substance. The following 
forms of wound healing may be recognized : 

Peeve aiine by first inten.tiem, 

Per ealino by second inte ntHon, 

Bee wealangotby third intention. 

feeihealing under scab, 

5. Abnormal granulation and cicatrization 

HEALING BY PRIMARY INTENTION.—Healing by first 
intention consists of a direct union of the margins 
Seethe wound through immediate agglutina- 
tion without suppuration. Healing by primary 
union depends on the following conditions : fresh, non-infected 
(aseptic) wounds, fresh incised wounds with even margins 
and, when possible, without loss of substance ; when infection 
has occurred careful disinfection must be employed (antiseptic 
treatment); the margins of the wound must be brought in 
close apposition by means of sutures; all foreign bodies (hair, 
dirt, blood, etc.) must be removed ; application of an aseptic 
bandage. In the domestic animals these conditions are 
usually applicable only to operation wounds, and then only 
when possible to afford protection by means of a bandage. 

Macroscopically healing by primary union first 
presents an agglutination of the edges of the wound with blood, 
afterwards a lymph-like plasmic fluid (so-called wound cement) 
exerts the same influence. The surface of the wound remains 
dry. About the second day the margins of the wound are 
slightly swollen, sensitive, andred. After about a week (four 
to eight days) definite union results with the formation of a 
small cicatrix. Microscopically one soon observes emi- 
gration of the white blood corpuscles from the neighboring 
blood vessels to the margins of the wound and to the wound 


18 HEALING BY FIRST INTENTION 


cement. This cellular infiltration ose 
wound with wandering white blood corpus- 
clesis considered a process of inammauqrac 
Wandering of the white blood corpuscles is due to a traumatic 
irritant (traumatic, aseptic inflammation) and is to be consid- 
ered, therefore, as a reactive manifestation on the part of the 
injured tissue. According to recent investigations bacteria 
which gain entrance to a wound that heals by primary union 
are soon rendered harmless and partly resorbed ; this is prin- 
cipally due to the bactericidal properties of the blood serum 
(antitoxins, alexins) which is one of the constituents of wound 
secretions. The infiltration of the wandering cells (leuco- 
cytes) in the wound cement and margins of the wound reaches 
its height on the third day; from that time they degenerate 
or return to the vessels. 

The wandering cells take no part in the formation of the 
definitive cicatrix, a former erroneous supposition. The 
cicatricial tissue develops from the so-called 
fibroblasts; these are round cells which arise 
from the proliferation of the fixed Gaipeen 
thonous) connective tissue cells and the 
endothelium of the vessels. The fibroblasts gradu- 
ally enlarge; large epithelioid, as well as long, spindle, and 
club-shaped cells are formed ; these are afterwards transformed 
into fibrillar, connective tissue cells when they form genuine 
cicatricial tissue. Simultaneously there occurs a 
budding process from the walls of the incised 
capillaries, new vessels are thus formed oa, 
tween the margins of the wound. The fibroblasts 
in combination with the newly formed vessels form the so-called 
germinal tissue (granulation tissue); this is a cellular and 
vascular new formation. After the transformation of the 
fibroblasts into connective tissue cells the granulation tissue 
contracts so that the newly formed vessels atrophy again; thus 
the formation of the genuine cicatricial tissue is com- 
plete. Finally the cicatricial tis suememegae 
pletely covered by proliferations from the 
epidermal cells (rete Malpighi, epithelium 


HEALING BY SECOND INTENTION 19 


of the dermal glands) atthe margins of the 
wound. ‘This completes the process of healing ‘by primary 
union. . 

HEALING BY SECOND INTENTION.—This mode of 
healing occurs with suppuration as a result 
Or intection with ordinary pus cocci. It is 
characterized by the formation of an abun. 
dance of granulationtissue. One finds this form of 
healing in old wounds, wounds that have become infected, 
those that have not received aseptic treatment, contused 
wounds, wounds with a loss of substance, or those which can- 
not be sutured. 

Macroscopically, within the first twenty- 
four hours the individual tissues and blood may be readily 
differentiated on the surface of the wound. A serous, lym- 
phatic, reddish-yellow secretion is formed after one or two 
days, giving the surface of the wound a gelatinous appear- 
ance. From the second to the third day the sur- 
face of the wound presents a granular ap- 
pearance (granulations), pus begins to form. 
During the course of the suppuration the necrosed tissue is 
sloughed off, the wound is ‘‘self-cleansing.’’ Later, the gran- 
ulating wound surface is gradually covered with epidermis 
from the margins of the wound, the newly-formed epidermis 
surrounds the margins of the granulations in the form of a 
light colored fringe. The granulation tissue contracts and is 
completely covered, there finally remains a broad, firm, 
tendonous cicatrix. The microscopic changes 
are identical with those which occur during 
healing by first intention. The only points of dif- 
ference are that in healing by second intention infection takes 
place. The wound is irritated by bacteria and 
their products, which results in the forma- 
tion of large quantities of granulation tissue, 
this being the product of a suppurative inflammation it fur- 
nishes a purulent exudate. MHealing, therefore, re- 
quires a much longer time (two or more weeks). Cellular in- 
filtration of the edges, formation of the fibroblasts, budding of 


/ 


20 HHALING BY THIRD INTENTION 


the capillaries, and transformation of the fibroblasts into con- 
nective tissue proceeds exactly as in healing by first intention. 
Further, suppuration does not form an abso- 
lutely necessary condition for healing by 
secondary union. ‘The essential condition is the abund- 
ant formation of granulation tissue, which may occur without 
suppuration (aseptic granulations). | 

Granulation tissue formed during healing 
per secundam serves principally as a com-- 
pensation for the loss of substance) @yi gee 
dition .it.forms an important ‘proteepeee 
against the entrance of infectious irritants 
into the blood stream. The entrances to the lymph 
streams are mechanically closed by the granulation tissue, the 
pus also contains bactericidal properties (pus serum, like blood 
serum ; pus corpuscles, like white blood corpuscles). This 
explains the long known surgical fact, that with the formation 
of granulation tissue the danger from general infection is 
greatly diminished after the third day. Experimental inves- 
tigations upon sheep have also demonstrated that granulating 
wound surfaces are not permeable for anthrax bacilli or for the 
_ toxins of tetanus. ‘The protective action of granulations is of 
great importance, therefore, in veterinary science, as healing 
by primary union is seldom attained. Above all, the granula- 
tions supply the loss of substance when healing 
by primary union is impossible. Many wounds cannot heal 
except through the formation of granulation tissue (wounds 
of the cartilage and cornea). 

HkeALING BY THIRD INTENTION.—This consists in the 
artificial union of wound surfaces that are 
already granulating and suppurative 
sometimes follows careful disinfection and exact suturing of 
suppurative granulations. Healing by third intention should 
not be confused with scarification and suturing of granulating 
wounds (same as healing per prima). Healing by third in- 
tention is of considerable importance in veterinary surgery as 
certain forms of purulent lacerated wounds may be brought 
to rapid healing by this method. This is especially true of 


HEALING UNDER AN ESCHAR 25 


those about the head (false nostril), permanent union result- 
ing in wounds a week or more old. Healing by third inten- 
tion should always be given a trial, especially in the horse, 
when healing per prima cannot be expected from scarification 
of the wound surfaces. ) 

HEALING UNDER AN ESCHAR.—This is a form of pri- 
mary wound healing. ‘The blood dries on the surface 
of the wound and leads to the formation of a protective coat. 
In small wounds cicatrization without suppuration takes place 
rapidly beneath the eschar, new epidermis is quickly replaced 
from the margins of the wound. In veterinary surgery this 
method of healing is of great importance as many wounds can 
be neither sutured nor bandaged, the dry scab taking the 
place of the latter. It may be applied artificially by means of 
a hot iron, production of a necrotic covering (wounds 
of the ear, tail, joints, extirpation of small tumors from the 
backs of dogs), or by the application of tannin, tanno- 
form, glutol, amyloform, argentum nitricumor 
other disinfecting agents that produce an eschar. 

ABNORMAL GRANULATION AND CICATRIZATION.— While 
the various forms of normal wound healing by the processes 
of granulation formation and cicatrization lead, asa rule, after 
more or less time, to the formation of a typical cicatrix, 
many wounds form an exception tothisrule. The granulation 
and cicatricial process appears abnormal. This is true when 
foreign bodies or necrosed pieces of tissue remain in the 
wound, when there is great loss of substance, when continued 
infection or irritation occurs in fresh or healing wounds, when 

the injured animal is suffering from certain infectious dis- 
eases (see below). 

1. Granulations are especially abnormal when the 
granulation tissue forms too rapidly and in large quantities ; 
exuberant proliferations, fungus-like granulations 
(granuloma, caro luxurians, proud flesh). Excessive granu- 
lations are observed in treads on the coronet; fistulous 
withers or saddle galls when necrosed pieces of tissue are re- 
tained and act as a constant irritant to the part; in skin 
wounds on the flexor surfaces of the joints (carpus, tarsus) 


22 ABNORMAL WOUND HEALING 


when continually irritated by flexion and extension move- 
ments of the limbs; in muscle prolapse as a result of con- 
striction and continued irritation of the exposed part after 
injury to the fascia of the limbs, in intensive suppurative infec- 
tion. Other diseased forms are: erethistic granulations, 
that is, sensitive, dark-red, easily hemorrhagic, and very pain- 
ful granulation tissue; atonic (torpid, asthenic) weak or 
deficient, as wellas unequal granulation, and gangren- 
ous degeneration of the granulation tissue (diphtheria of 
the granulations). 

2. Cicatrization may become abnormal in various. 
ways. Great loss of substance results in an incomplete 
cicatrix ; suppurative decomposition in the formation of an 
ulcerorfistula. In horses there is frequently observed 
on the cicatrix an abundant accumulation of horny epidermal 
cells (horny cicatrix). Occasionally one observes a tumor- 
like proliferation of the cicatricial tissue (cicatricial keloid, 
cicatricial hypertrophy). This is seen in horses in the flexor 
regions of the fetlock and coronet (compare with chapter on 
keloids, under tumors). So-called painful or sensitive 
cicatrices (neurectomy, throat, shoulder) are rare in the 
horse. A cicatricial contracture occasionally results 
from extensive destruction of the skin, that is, cicatricial con- _ 
traction of the neighboring skin leads to change in position of 
parts of the body (caput obstipum from contraction of the 
tissues of the neck ; stilt-foot in necrosis of the skin on the 
posterior surface of the carpus and metacarpus; ectropium 
from extensive wounds of the eyelids). 

The causes of atypical wound healing are 
both local and general. Under local causesare mechanical 
lesions of the tissues (contusions, constant irritation from 
foreign bodies, licking, rubbing, and movements); irritation 
of the wound through chemical irritants (antiseptics, 
decomposing secretions, necrosed particles of tissue); in fec- 
tion of the wound through specific inflammatory irritants. 
(botryomyces fungi, glanders, necrosis bacillus), or by means 
of various other especially virulent, pus forming bacteria ; 
deranged circulation (anaemia, hyperaemia, throm- 
bosis). Neurectomy, asa local cause of deranged circula- 


WOUND HEALING IN DIFFERENT TISSUES 23 


tion and nourishment, may influence normal wound healing 
(injuries to the hoof). General causes ‘of disturbed wound 
healing are: febrile general diseases; chloroform 
fmeauced activity of the white blood corpus- 
Pies. weakening of thei activity .of the heart); 
@ravage; general weakness and conditions. of 
exhaustion; weak constitution; faulty breed- 
Meecare and food; diseases of the kidneys; 
Mmeretcwmia Ss cancerous (cachexia; | diabetts,’ 
Also the race and species, as well as the condition of the 
stable, temperature, season, climate, etc., all have an influence 
on the healing of wounds. Finally, many animals have 
idiosyncrasies which interfere with normal wound healing 
and favour the entrance and multiplication of infectious ma- 
terial. On the other hand, many animals appear to have 
congenital immunity against wound infection diseases ; 
wounds on native born Algerian horses, for example, heal 
without suppuration and without treatment. 


WOUND HEALING AND REGENERATIVE ABILITY OF DIFFERENT 
TissuEs.—1. Wound healinginthe skin, pododerm and mucous 
membrane takes place according to the previously described methods. 
Regreneration is most rapid in the following tissues: 
epidermis, skin and pododerm (formation of horn), 
the epithelium of the mucous membranes, as well as 
the connective tissues. 

2. Muscle wounds do not heal by regeneration of muscle fibers, 
but by means of a fibrillar, connective-tissue cicatrix. The regen- 
erative ability of muscle is very slight. Proliferation and 
enlargement of the muscle cells occurs only in the vicinity of con- 
nective tissue cicatrices, as well as in small, superficial injuries to the 
muscle, even here the formation of new muscle fibers is limited. 

3. Tendon wounds heal principally through proliferation of 
the cells of the tendon sheath, of the paratendineum, 
and the interfascicular connective tissue, the genuine 
tendon cells of the tendon stump also take part. The granulation tissue 
that results from this proliferation unites both ends of the tendon and 
gradually changes into genuine tendon tissue (compare with the chapter 
on rupture of tendons). 

4. Wounds of the bone heal in the same manner as fractures, 
through ossification of the granulation tissue (callus); this 
is formed from the periosteum and bone marrow, as well as the bone 
itself (periostitis, osteomyelitis, and ostitis ossificans) 
(compare with chapter on healing of bone fractures). 


24 WOUND HEALING IN DIFFERENT TISSUES 


5. Cartilage wounds that are covered with perichondrium (lateral 
cartilage, trachea, muscles of the ear) heal, similar to bone wounds, 
through proliferation of the perichondrium with the 
formation of a callus that is at first fibrous and afterwards 
ossified. The cartilage cells that fall directly into the cartilage 
wound undergo fatty degeneration. Synchronous with the prolifera- 
tion of the perichondrium there occurs a multiplication of the neigh- 
boring cartilage cells with a new formation of cartilage tissue. 
In non-vascular articular cartilage, however, the relation is very 
different. Aseptic, clean, cartilage wounds in‘the joing 
never heal, they remain as a permanent defect. Infected, articular- 
cartilage wounds, on the other hand, healcompletely. Severe irritation 
of the non-vascular tissue of the wound leads to the formation of 
granulations and a connective-tissue cicatrix. Afterwards the connective- 
tissue cicatrix may be even partly transformed to hyaline tissue. 


6. The peripheral nerves, when injured, possess an ex- 
tremely active regenerative ability. Whenanerve suture is 
applied replacement takes place through new formation 
of nerve fibers from the old nerve fibers of the central 
stump; these new fibers grow into those of the per- 
ipheral stump. When the ends of the nerves, however, remain 
at least one centimeter apart (neurectomy) the peripheral portion 
of the incised nerve degenerates, while the central nerve 
stump anastomoses with neighboring nerves, in this manner the 
conductivity is again established. At the same time new nerve fibers 

sprout from the central stump, which fill in the defect between the 
ends, and extend along the course of the peripheral portion. In this 
manner the nerve is replaced, when degeneration was complete, or 
fusion may occur when the fibers are still intact (chemotatic influence 
of the products of degeneration of the old nerve fibers on the growing 
central nerve cylinder). Asaresult of constant irritation (neuritis) the 
central nerve end undergoes a new formation of nerve fibers and con- 
nective tissue, this results in a club-shaped swelling (neuroma). 


7. Inthe brain and spinal-marro w—in contrast to the per- 
ipheral nerves—regeneration of nerve substance does not 
occur; there is a formation of connective-tissue cicatrix similar to 
that which occurs in regeneration of muscle. 


8. In the non-vascular cornea healing of wounds is similar to 
that in vascular tissues. One first finds migration of white blood cor- 
puscles from the neighboring conjunctiva and schlera, as well as a sub- . 

‘sequent autochthonous cellular proliferation with the formation of 
fibroblasts and the successive transformation of these into fibrillar con- 
nective-tissue. The formation of new vessels in the cornea, 
however, does not take place in the corneal tissue, but 
proceeds from the margin of the sclera. 


WOUND INFECTION DISEASES 25 
V. WOUND INFECTION DISEASES. 


DEFINITION.—The term wound infection. dis- 
eases or accidental wound diseases embraces the 
general surgery of a long list of affections due to wounds 
which depend on the entrance of microorganisms or 
their products (toxins). The bacteria gain entrance to 
the wounds by contact or through the air. They maintain 
local disease processes in the wound or some form of general 
derangement. In a narrow sense the most important wound 
infection diseases are: 1. Suppuration, 2. Phlegmon, 3. Ab- 
scess, 4. Wound Fever, 5. Septicaemia, 6. Pyaemia. The 
following diseases may also result from the wound: inflam- 
mation of the lymph vessels (lymphangitis), inflammation of 
the veins (phlebitis), as well as erysipelas. In‘a broader 
sense wound infection includes tetanus, glanders, 
rabies, botryvomycosis, actinomycosis, tuber- 
culosis, malignant edema, strangles, anthrax, 
black leg, and Wildseuche. The following in- 
¢ludes a description of the wound diseases in the narrow sense. 


I. SUPPURATION OF WOUNDS. 


CAUSES.—Suppuration which accompanies healing by 
second intention is a product of inflammation caused by in fec- 
tion of the wound with pus cocci. The following 
have been found most often on bacteriological examination : 
staphylococcus and streptococcus (staphylomycosis, strepto- 
mycosis). The following are the most important pus forming 
bacteria : 

a) Staphylococcus pyogenes aureus is the 
most frequent pus coccus in animals, especially the horse. 
They are in the form of small, round, non-motile cocci; ar- 
ranged as lobules, clusters, or as diplococci; on potatoes, 
agar, and gelatine they form orange-yellow cultures. Experi- 
ments have demonstrated the fact that their action is due to 
the production of toxins which act as an irritant and produce 
inflammation. Subcutaneous injection of a pure culture usually 
results in the formation of an abscess; intra-abdominal 


26 PUS-FORMING BACTERIA 


injection in fatal suppuration ; injection into the blood, py ae- 
' mia as well as ulcerative endocarditis. Repeated injections. 
have resulted in the seemingly rapid formation of amyloid 
degenerations (liver, kidneys). Staphylococcus pyogenes 
aureus is especially common in circumscribed, localized 
suppuration, in pyaemia, and in the pyaemic form of 
foallameness: 

b) Staphylococcus pyogenes albus is» less 
common. It is distinguished from the preceding form by its 
less virulent pathogenic action, and white, varnish-like cul- 
tures. According to some, it is the cause of moon blind- 
ness (?). 

c) Staphylococcus pyogenes citreus is rare. 
It is characterized by the citron-yellow color of its cultures, 
otherwise it is identical with the preceding. 

d) Streptococcus pyogenes is next in importance 
to staphylococcus pyogenes aureus. It forms cocci arranged 
in the form of a chain; it does not grow on potatoes, on 
gelatine it forms very small white colonies. Streptococcus 
pyogenes is a special cause of progressive phlegmon- 
ous suppuration with subsequent septicaemia. It 
is found, therefore, in the septic form of foal lameness. 
It also appears to be identical with the streptococcus of erysip- 
elas, strangles, contagious pleuro pneumonia, acute articular 
rheumatism, and petechial fever (?). 

e) Bacillus pyogenes appears to be the most 1m- 
portant cause of pus formation in cattle and swine; see 
page 36. | 

f) Bacillus pyocyaneus—the bacillus of blue 
and green pus—forms small, slim, very motile bacilli. They 
frequently possess four to six flagella. Through the decom- 
position of albumen they produce a blue and yellowish-green 
coloring material (pyocyanin, pyoxanthin) similar to the 
bacilli of blue milk. Chemically this is closely related to 
anthracine, it also belongs to the benzol group, and colors the 
pus and bandage blue or greenish-yellow. While the coloring 
material is harmless, the bacilli and their toxins have a patho- 
genic action towards experimental animals, producing an 


PROPERTIES OF PUS 27 


edematous and suppurative inflammation at the point of in- 
jection. Bacilli with red coloring material are also found in 
pus. 
CoLon BaciLLus.—The colon bacillus (Bacillus coli communis, 
Bacterium coli commune) is found in various varieties in the normal 
intestinal canal. It is present in many species and races, and is usually 
a harmless organism because its very poisonous toxins are neutralized in 
healthy animals by the action of the gall. Under certain unknown con- 
ditions the colon bacillus in the intestinal canal becomes highly viru- 
lent (calf diarrhoea, calf septicaemia, enteritis, peritonitis, cystitis, 
pyelonephritis, hepatic abscesses, endometritis, septicaemia puerperalis, 
polyarthritis and omphalo-phlebitis in the calf, malignant head catarrh in 
cattle, croupous enteritis in cats, as well as various other ‘‘colon bacilli’ 
infections). Inthe subcutaneous connective-tissue it causes suppura- 
tion with more or less serious phlegmons (septic and gas phlegmon). 
It is alleged to be identical with Bacterium phlegmasiae uberis, bacillus 
foetidus, neapolitanus and lactus aerogenes. . 

The following microorganisms may also cause suppuration under 
certain conditions: actinomyces and botryomyces fungi; the bacillus 
of glanders; the streptococcus of strangles; the cocci of contagious 
pleuro pneumonia; the micrococcus pyogenes tenuis and tetragenes ; 
the capsule coccus (diplococcus); the bacillus pyogenes foetidus; the 
staphylococcus cereus, albus, flavus; proteus vulgaris, and others. 
Finally, the courses of many infectious diseases; namely, suppurations 
of tuberculosis and actinomycosis are, frequently accompanied by 
mixed infections of ordinary pus bacteria, For further informa- 
tion on suppuration, in regard to pus bacteria found in individual do- 
mestic animals, as well as on the development of so-called aseptic 
inflammation (injections of oil of turpentine, sublimate, nitrate of 
silver) compare with the chapter on inflammation. 

PROPERTIES OF Pus.—Under ordinary conditions pus 
forms a thick, creamy, yellowish or greenish, non-odorous, 
non-coagulable fluid (pus bonum et laudible). Asa result of 
infection with bacteria which produce a colored secretion the 
pus may be green or blue, seldom yellow. Thin, mucous-like, 
frothy, odorous pus indicates the presence of decomposition as 
a result of colonization of septic bacteria in the wound. The 
condition and quantity of the pus varies with the size and age 
of the wound, the blood supply and consistence of the wound, 
the species, quantity and virulence of the bacteria, tempera- 
ture and season, climate, breed, etc. Pus from the horse is 
usually yellowish and cream-like ; that of cattle and birds is 


often caseous ; that of swine tenacious and green. 


28 PHLEGMON 


When pus remains for a long time in a vessel one observes 
two layers. The upper isa thin, apparently clear, and yel- 
lowish fluid ; it forms the so-called pus-serum. Theunder 
layer is thick and straw-yellow ; it contains the pus-corpus- 
cles. The pus-corpuscles are formed princi- 
pally from the white bloodcorpusclegmia 
migrate from the blood vessels (Cohnhem). 
Part of them, however, are descendants of the fixed connec- 
tive-tissue cells, as well as the degenerated connective-tissue 
substance of the tissue. Upon microscopic examination one 
finds, in addition to the pus corpuscles, various forms of pus 
cocci which are occasionally enclosed within the pus corpus- 
cles. There are also observed various other bacteria, red 
blood-corpuscles, tissue cells, drops of fat, crystals of fatty 
acids and cholesterin. The recognition of cartilage cells and 
giant cells in the pus are of special importance in the diagnosis 
of cartilage and bone fistulae. The peptone contents of the 
pus is due to the transformation of the fibrinogen through the 
activity of the pus forming microorganisms ; absence of fibri- 
nogen in the pus accounts for its non-coagulability. 

When the suppuration does not remain confined to the 
wound, but involves the neighboring tissues in a suppurative 
inflammation, it leads to the development of a diffuse suppu- 
rative inflammation of the subcutaneous and submucous cellu- 
lar tissue (Suppurative phlegmon), a circumscribed 
accumulation of pus (abscess), a suppurative inflammation 
of the lymph vessels (lymphangitis), lymph glands 
(lymphadenitis), and veins (phlebitis), as well asthe 
entrance of pus cocci andtheir toxins into the blood 
(wound fever, septicaemia, pyaemia). Compare 
with the subsequent chapter. 


2. LHE GPHLEGMONGS: 


DEFINITION.—Phlegmon, phlegmonous inflam- 
mation, or inflammation of connective tissue 
are terms used to indicate an infectious, serous, or suppurative 
inflammation of the connective tissue and all its parts ; namely, 
the subcutaneous, submucous, subfascial, intermuscular, peri- 


PHLEGMON 29 


osteal, perichondral, tendo-vaginal, and interglandular connec- 
tive-tissue. One speaks, then, of a subfascial or intermuscu- 
lar phlegmon, of a phlegmon of the subcutis, the perichon- 
drium, the tendon-sheaths, the udder, etc. 

CAUSES AND Forms.-—Phlegmonous inflammation is due 
to the same bacteria that are found in suppuration. The 
streptococcus pyogenes and staphylococcus 
pyogenes aureus are the most frequent causes of phleg- 
mons (phlegmone streptococcia or streptomycosis ; phlegmone 
staphylococcia or staphylomycosis). The pus cocci usually 
gain entrance to the connective tissue through wounds ; punc- 
tured, contused, and lacerated wounds form the ordinary 
sources of phlegmons. Very often the previous wounds are 
very small or entirely healed so that they can no longer serve 
as a source of entrance to pus forming bacteria. Formerly, the 
erroneous term of so-called spontaneous phlegmon was given 
to this condition. Phlegmon may occur ata point more or 
less removed from the point where the pus cocci gain entrance ; 
they being carried to this point through the lymphatic circu- 
lation. It may also occur that the infection of the connective 
tissue proceeds, not from without, but from the blood stream 
(metastatic or symptomatic phlegmon of pyaemia, 
strangles, contagious pleuro pneumonia, glanders). Hemor- 
rhage and lacerations of connective tissue as a result of con- 
tusions predispose to phlegmons. 

Surgically there are various forms of phlegmon. 
Classified from an anatomical standpoint we have—subc u- 
taneous, submucous, subfascial, intermusctu- 
lar. Itisalso spoken of as superficial and deepcCe.g. 
subfascial), orcircumscribed anddiffuse phlegmon. 
The circumscribed form confines itself to a phlegmonous swel- 
ling in the vicinity of the wound and frequently leads to the 
formation of an abscess (phlegmonous abscess). Diffuse 
phlegmon consists of an inflammatory infiltration 
of large areas of connective tissue and frequently results in 
necrosis of the skin, subcutem, fascia, tendons, tendon sheaths 
(gangrenous phlegmons), whereby other bacteria may 
also play a part (necrosis bacillus). 


30 PHLEGMON 


Septic phlegmon, in contrast to the ordinary form, is 
especially virulent. Itis also termed progressive phleg- 
mon, progressive inflammation of the cellular tissue, or gan- 
grenouserysipelas. It is due toa mixed infection of pus cocci 
and specific septic bacteria (streptococcus septicus, micrococ- 
cus tetragenes, colon bacillus, and others). It is character- 
ized by a rapid, extensive, ichoric suppuration of the cellular 
tissue, with a severe, often fatal general infection. The so- 
called gas phlegmon is a mixed infection composed of gas- 
forming bacteria (bacillus phlegmonze emphysematose, colon 
bacillus). The ordinary suppurative phlegmon is termed 
simple in contrast tothe specific phlegmons. ‘The latter 
are not due to pus cocci, but to certain other bacteria, espec- 
ially the bacilli which cause malignant edema and ery- 
sipelas (compare with the chapter on these subjects). 

GENERAL SYMPTOMS OF PHLEGMON.-Circumscribed 
phlegmon is characterized by swelling, high temperature, 
and pain over a small area of the skin. At first the swelling 
has a well defined boundary ; on palpation it may be hard and 
firm, or soft and fluctuating. Asa result of the swelling and 
tension the skin cannot be raised. Circumscribed phlegmon- 
ous swellings frequently result in the formation of an abscess ; 
it is characterized by fluctuation, a reddish-blue or dark 
grey color of the skin, and fever. Spontaneous evacuation 
may occur after necrosis of a small portion of the overlying 
skin. Healing follows by the formation of granulation tissue, 
when not evacuated artificially it may result in burrowing of 
pus as well as in progressive phlegmon. Suppurative lym- 
phangitis, lymphadenitis, phlebitis, as well as pyaemia and 
septicaemia may also occur. 

Diffuse phlegmon is characterized by extensive 
swelling of the skin—especially on the limbs—fever, and pain 
(lameness). Subfascial phlegmon is accompanied by 
especially high fever and severe pain, when the deeper layers 
are affected the skin may remain unchanged, or presents a 
slight, edematous, doughy swelling. Intermuscular 
phlegmon issimilar in appearance. All diffuse phlegmons 
frequently lead to extensive necrosis of the skin, subcutem, 


PHLEGMON 31 


fascia, muscle, etc. They often result in fatal septicaemia or 
pyaemia. } | 

Septic phlegmon is very acute, spreads rapidly, and 
usually terminates in death. It is characterized by a high 
septic fever, extensive gangrenous destruction of the subcutem 
and neighboring soft parts, namely, the muscles, which are 
transformed into a discolored, odorous, punk-like, fatty mass, 
or a thin, ichoric discharge. The diseased parts may crepitate 
as a result of the formation of foul gases (gas phlegmon, septic 
emphysema). 

TERMINATION.—The course of phlegmons varies ac- 
cording to their character and extent, as well as with the genus 
of the animal. 

1. Circumscribed and diffuse phlegmons are followed by 
healing through resorption. ‘The latter, especially, frequently 
heal without necrosis or abscess formation. 

2. Abscess formation may result from any kind of 
phlegmon. The prognosis is more favourable when the phleg- 
monous inflammation is situated near the surface. Subfascial 
and intermuscular abscesses are a source of danger, they may 
be in the form of numerous, small pus foci, or converge to 
form a large abscess, general infection is liable to occur. 
Occasionally subfascial abscesses rupture spontaneously on 
the surface. 

3. Necrosis may result from any form of phlegmon,. It 
most often results from septic, subfascial, intermuscular, peri- 
osteal, and perichondral phlegmons, especially when there 
occurs a simultaneous influence of the necrosis bacillus (fistu- 
lous withers, poll evil, quittor, phlegmon of the planter 
cushion). Necrosis often forms the sourceof septicaemia 
and pyaemia. 

4. Encapsulation of abscesses is most often ob- 
served in intermuscular phlegmon (shoulder abscess). In dif- 
fuse, subcutaneous phlegmons on the posterior limbs of the 
horse the phlegmonous process is occasionally suspended for a 
long time, healing is only apparent ; sooner or later the phleg- 
mon returns. Possibly this recurrence explains a previous 
encapsulation-isolation of individual disease foci, with a sub- 


32 PHLEGMON 


sequent spreading of the inflammatory process as a result of 
rupture, laceration, or liquefaction of the capsule. 

5. Chronic induration or schlerosgitaaa 
curs when a diffuse, suppurative phlegmon terminates in a 
chronic connective-tissue proliferation of subcutaneous, inter- 
muscular, subfascial, and perichondral tissue. Schlerosis oc- 
curs on the posterior limbs after phlegmons (elephant leg), 
grease, or on the head (glanders), and leads to pronounced 
thickening of the skin; it is termed elephantiasis, 
pachyderma, or schleroderma. Compare with 
the chapter on elephantiasis. 

TREATMENT.— When there is no evidence of abscess for- 
mation and resorption is possible, treatment consists in the 
application of moist, hot fomentations (Prieznitz), 
or disinfecting bandages (spirits of camphor 
bandage); antiseptic lotions, warm baths an 
cataplasms; ointments of camphor, iodoform, 
tar; carbolic acid, creolin, grey) meteuens am 
well as subcutaneous injections of disinfec- 
tants. In subacute, and in chronic phlegmons especially, 
resolution or accumulation of the pus in a circumscribed cavity 
may be attained by the application of a severe counte - 
irritant in the form of tincturé of 10d 1pepgpmae 
guentum hydrargyri cinereum. ATecoOliiieee 
very good internal resorbent. 

All abscesses, on the other hand, should be treated early 
by meansofa free incision. Experimental investigations. 
as well as practical experience have demonstrated that early 
evacuation of the pus by means of opemmiace 
sions is the most satisfactory treatment (disinfectant activity 
of the oxygen of the air). One may also irrigate the abscess 
cavity with antiseptic fluids and provide drainage. 
All necrotic tissue must be removed (amputation of the tail 
and claws ; resection of the lateral cartilage and the flexor 
tendon at its point of attachment to the os pedis). The 
application of massage is contra-indicated, 
especially for acute phlegmons. 

OCCURRENCE. — Most phlegmons are subcutaneous. 


PHLEGMON 33 


Phlegmonous inflammations of the subfascial, intermuscular, 
and perichondral connective tissues, as well as the tendon 
sheaths are common, especially in the horse. Septic phleg- 
mons are very common in horses and dogs. The following 
aaa are of special practical importance : 

. subcutaneous phlegmon of the soft parts of t th e 
hea 4 (lips, eyelids, zygomatic region, pharynx); throat, 
and shoulder (subcutaneous injections) ; 

2. Submucous phlegmon of the mucous membranes 
of the mouth and throat (stomatitis,. glossitis, 
pharyngitis) ; 

3. Subfascial phlegmon of the fasciae of the throat, 
shoulder, and back (poll-evil, fistulous withers); 

4. Phlegmonof the muscles of the throat shoul- 
der, elbows, gluteal region, and abdomen in the 
horse (deep wounds); 

5. Subcutaneous phlegmons of the posterior limbs 
of the horse in both forms: the ordinary simple and 
the rare, characterized by abscess formation; 

6. Subcoronary and perichondral phlegmons at 
the coronet (treads on the coronet), and the lateral ‘carti- 
lages (fistulae of the lateral cartilages), as wellas phlegmon 
of the planter cushion in the horse (nail punctures); 

7. So-called panaritium of the claws of cattle and 
dogs, corresponding to the subcoronary phlegmon of horses 
(see below); | 

8. Subfascial phlegmon of the fascia lata and the 
tibial fascia inthe horse (punctured injuries, wounds 
from blows); 

g. Phlegmon of the tendon-sheaths of the flexor 
tendons in the horse (traumatic, suppurative, and metastatic) ; 

1o. Subcutaneous and intermuscular phlegmon of the 
tail in cattle (lung plague injections, so-called tail worm), 

_ dogs (contusion), and horses (amputation ); hi 
EN 11. Phlegmon of the sheath and scrotum in the 
horse (wounds, castration, glanders); 

12. Phlegmon of the udder in cattle (small wounds, 
erysipelas, and furunculosis); 


34 PANARITIUM 


13. Puerpural phlegmon in cattle (septic gas-phleg- 
mon, so-called puerpural blackleg) from small contused 


wounds of the vulva and vagina at birth. 

PANARITIUM.—This name (derived from paronchium—inflammation 
of the bed of the nail—matrix unguis—) indicates a circumscribed 
phlegmon of the phalanges. In man, it applies to a special 
circumscribed, suppurative inflammation of the subcutaneous connec- 
tive tissue on tue volar surface of the finger. The word is derived from 
human medicine, and in veterinary science the application is somewhat 
false. In man the anatomical structure of the subcutis predisposes to 
the existence of panaritium. The subcutaneous tissue on the volar 
surface of the finger is very thick, and its connective-tissue fibers are 
not parallel with the finger, but run perpendicular to it. Upon the 
entrance of pus cocci there first occurs a circumscribed inflammatory 
focus surrounded by fixed connective-tissue fibers (panaritium). The 
phlegmonous process extends from here to the tendon-sheaths, the 
periosteum, the joint, and the bone, there exists a progressive phleg- 
mon (panaritium tendonosum, periostale, articulare, osseum) which may 
lead to necrosis of the bones, suppurative inflammation of the joints and 
tendon-sheaths, to necrosis of the tendons, and death of the entire 
phalanges, even to fatal septicemia and pyemia. Very similar pro- 
‘cesses occur on the hoof of the horse, the claws of cattle, sheep, 
and dogs. Allthe above forms of panaritium can be observed in the 
‘sheep and dog especially. In cattle one can distinguish panaritium of 
the toes, panaritium between the claws and between the balls. The 
term phlegmon is more often employed. Subcoronary phlegmon of 
the horse is analagous to panaritium when it is complicated with 
phlegmon of the planter cushion, of the perichondrium, of the bursa of 
the navicular bone, as well as with necrosis of the flexor perforans, 
with fistula of the cartilage of the hoof, and suppurative inflammation of 
the pedal joint. 


3. ABSCESS. 


DEFINITION AND CaAusES.—Abscess (abscessus, apos- 
tema) isan accumulation of pus which is usually the 
product of a suppurative inflammation; it may de- 
velop from suppurative phlegmons, suppurative wounds, puru- 
lent hematomata, or metastatically through the blood. Pus 
bacteria, are the most frequent causes of abscess formation 
(staphylococcus and streptacoccus pyogenes). Abscesses in 
horses are very often due tothe streptococcus of stran- 
gles and the botryomyces fungus. In other cases 
the abscesses contain diverse bacteria; occasionally the mi- 


oa 


ABSCESS SO 


erococcus tenius, the bacillus pyogenes fetidis, the colon 
bacillus, and other “bacteria are the causes of abscesses. Oc- 
casionally abscess formation is due toa mixed infection 
with various microorganisms (tubercular and actinomycotic 
abscesses). In addition to pyogenic bacteria gas-forming or- 
ganisms may gain entrance, for example, bacillus phlegmonae 
emphysematosae, thus the so-called gas abscesses exist. 


Pus BACTERIA IN DIFFERENT DOMESTIC ANIMALS.—In HORSES 
staphylococci and streptococci, as wellas botryomyces, are the most fre- 
quent causes of suppuration. According to Hell there are no positive 
differential characteristics between the coccus of contagious pleuro- 
pneumonia and pus cocci; the former may result in pus formation. 
Foth found streptococci of strangles and staphylococcus aureus in a 
strangles-abscess in the horse; he is of the opinion, that under certain 
conditions, suppuration occurs in horses not affected with strangles, asa 
result of the activity of a streptococcus that cannot be differentiated 
from that of strangles by means of our present bacteriological methods. 
Schuemacher and Willach found a diplococcus in pus taken from a 
wound on a horse; they were unable to discover any differential char- 
acteristics between this and the cause of contagious pleuro pneumonia. 
They thought that many suppurative processes were related, therefore, 
to contagious pleuro pneumonia. For shoulder abscess in the horse 
Bossi named a special pus-organism (micrococcus myositidis equi aureus 
and albus). According to Baldoni the cocci of shoulder abscess in the 
horse are identical with the pus cocci of man, except that they are more 
virulent. According to Jensen botryomyces fungi are the principal 
organisms in shoulder abscess. Schmidt found strangles cocci in a 
shoulder abscess. I, myself, found botryomyces fungi in 25-50% of 
shoulder abscesses ; ordinary pus cocci in 50-75%; occasionally strep- 
tococci of strangles were found. Lucet and Nocard maintain that 
abscesses in CATTLE are caused by special pus-organisms that have 
not yet been described, that they have demonstrated them bacterio- 
logically and given them special names as follows: streptococcus, 
staphylococcus, and "bacillus pyogenes bovis; bacillus liquefaciens pyo- 
genes bovis, and bacillus crasus pyogenes bovis. The bacillus pyogenes 
bovis is identical with bacillus pyelonephritidis. In SwiInx, ac- 
cording to Grips, the bacillus pyogenes suis is a specific pus-forming 
bacterium that can be demonstrated in nearly all abscesses. Kunneman 
found a special bacillus in 90% of all processes in cattle, which he named 
bacillus pyogenes bovis; this is not identical with Lucet’s bacillus. 
Pure cultures of this organism produce subcutaneous abscesses in cattle, 
in the vagina they cause a suppurative vaginitis. According to Glage 
the bacillus pyogenes suis and bovis are identical; it forms the most 
frequent pus-organism in swine and cattle, and is apparently transmitted 


36 ABSCESS 


to swine through the milk of cattle suffering from disease of the udder. 
Jensen found the colon bacillus in prostatic abscesses in the DoG, he also 
found the same organism in suppurative peritonitis, cystitis, and pyelo- 
nephritis in the same animal. 


Forms oF ApscEss.—The following forms of abscesses 
are recognized; hot or cold (caused by acute or chronic 
suppurative inflammation). Cold abscesses are usually of 
tubercular, actinomycotic, and botryomycotic origin. Other 
classifications are: superficial and deep, primary 
and secondary, symptomatic or mMmetastwae 
(strangles, pyaemia, tuberculosis, glanders), simple and 
multiple, congestive or wandering (wandering 
abscesses either pass downward from their own weight, or 
upward in the hoof, passing in the direction of least resist- 
ance), subcutaneous, subfascial, intermuscu- 
lar, strangles, bone, or hoof abscess. One also 
speaks of a fecal or urinous abscess. 

OccURRENCE.—Abscesses occur in all domestic animals, 
especially in horses, dogs, and cattle. Avian abscesses have 
a peculiar, dry, caseous appearance. Abscesses are usually 
found in the subcutis, lymph glands, beneath fascia, in 
muscles, and in the mammae; bone-abscesses are rare. In 
the horse they are most often found in the following parts: 
pharynx (abscess of the lymph glands), at the coronet (coro- 
nary abscess), throat (subcutaneous injection), shoulder 
(shoulder abscess), saddle positions, gluteal region, the leg, 
the anterior surface of the carpus, and the inner surface of the 
metacarpus. In the dog their favorite seat is on the head and 
throat (bites). Abscesses in old cattle usually Cee slowly 
(cold abscesses). 

Symptoms.—A subacute abscess has the appearance of a 
circumscribed, hot, painful swelling. It is fluctuating 
at the center and firm at the periphery. The skin is adherent 
over its surface. Inthe absence of pigment one observes a 
reddish-blue or grayish discoloration of the skin, it also has a 
glistening appearance. Fever often exists at the same time. 
Deep, or subfascial abscesses are characterized by a diffuse 
swelling without fluctuation. 


WOUND FEVER a7 


In differential diagnosis one must distinguish 
between hematomata, phlegmons, galls, and new formations. 
An abscess is diagnosed as follows: it develops gradu- 
ally under inflammatory conditions, it fluctuates, the 
skin is moveable onthe surface, discoloration in 
white-skinned horses. Fever may alsoexist. To diagnose 
a deep or subfascial abscess it may be necessary to use an 
exploring needle. Sometimes deep abscesses are char- 
acterized by a high, septic, continuous fever, and by an 
intense, diffuse, very painful swelling. 

TREATMENT.—The treatment of abscesses is purely 
eereical,, It consists in-early and complete in- 
cision with subsequent antiseptic irrigation. 
The formerly used ‘‘expective’’ treatment—-waiting for spon- 
taneous discharge of pus—is no longer considered good surg- 
ery. ‘The skin becomes necrotic, the process is prolonged, 
suppuration is more extensive, especially in subfascial 
abscesses, when the life of the patient is in danger. Very 
large abscesses, especially subfascial, should be drained. 
Caution is required when opening deep abscesses in the vicinity 
of the larynx; only the skin should be incised with a knife, 
then bore with the fingers or some blunt instrument (sound, 
blunt pointed scissors) to the depth of the abscess. The 
opened abscess should not be tamponed, but 
treated as4an open wound and drained. Cold 
abscesses may be treated with extirpation of their capsule 
(shoulder abscess), sutured, and then drained. Subfascial 
abscesses with pronounced extention, and necrosis of the 
neighboring fascia and muscle (fascia of the withers in the 
horse as a result of fistulous withers) are occasionally incurable 
{septicaemia). 


4. WOUND FEVER. 


NATURE AND CAUSES.—The term fever indicates a role 
of symptoms that are complex in character ; they are the re- 
sult of various derangements of the generalsystem. The most 
important are: elevation of temperature, increased 
frequency of the pulse, derangement of the distribution of the 


38 WOUND FEVER 


blood and blood pressure, as well as alteration in its 
composition. The digestive, respiratory, and nervous- 
system are also deranged. EHlevation of temperature is not 
the only symptom of fever. 

The exact changes that take place during the existence of © 
a fever are not yet fully understood. The most important 
changes, on the one side, seem to be increased assim- 
ilation, especially of albumen, as a result of changes in the 
blood ; on the other side, the heat center of the brain 
appears to play a part. This center regulates the distribution 
of the heat as well as the development of the heat in the body 
(caloric center). When the heat center is irritated, elevation 
‘of the temperature occurs ; when it is weakened or paralyzed, 
the body temperature becomes subnormal. Irritation of 
the heat center with a subsequent rise of temperature may be 
produced in various ways. Traumatic injuries from some 
instrument or asa result of other injuries (burns), or thermic 
through a high degree of heat (heatstroke, sunstroke), num- 
berless chemical agents (toxins, ferments, mallein, tuber- 
culin), reflex action asa result of pain (so-called nervous. 
fever). Conversely, the heat center may become weakened 
or paralyzed with a subsequent fall of temperature. The 
factors which cause this condition may be traumatic (de- 
struction of the heat center), thermic (cold), chemical 
(antifebrin, antipyrin). 

In wound fever increased assimilation is combined 
with alterations in the blood, derangement of the heat regu- 
lators, and irritation of the heat centers. Apparently this. 
is due to the resorption of dissolved bacterial 
toxins, as well as certain chemical jagenge 
found in the wound secretions. Wound fever may. 
be termed a resorption fever. If the resorbed material 
is of bactericidal origin—bacteria or their toxins—it is termed a 
septic or bacterial fever (infection-fever, intoxication- 
fever, septicemia, pyemia). In a great many cases fever 
accompanies mild wounds, for example, after castration, or 
non-infected wounds, subcutaneous bone fractures, blood ex- 
travasations. The fever is apparently caused by the resorption 


WOUND FEVER 39 


of ferment-like products produced by degeneration of the 
blood and tissues. Their action on the blood and nervous 
system is similar to that of the toxinsof bacteria. Fever thus 
Dreauced is ‘called aseptic or ferment fever. The 
chemical agents thus generated are ferments of the blood and 
tissues (fibrin-ferment, histozyme), organic material from the 
degeneration of cellular tissue (nuclein from the nuclei of 
white blood corpuscles, free hemaglobin), and occasionally 
glandular secretions. One observes aseptic fever after the 
transfusion of blood, as well as in horses that have been 
restrained. 


Symptoms—Hlevation of temperature in wound 
fever varies according to its intensity and course. In the dog 
and horse it is classified as mild (39.5° C); medium (40.5° C); 
high (41.5° C). Wound fever is sometimes continuous (sep- 
ticemia), sometimes remittent, usually however, atypical. 
It is seldom intermittent (pyemia). Aseptic wound fever 
is not characterized by pronounced general symptoms, for 
example, that following castration in the horse. In septic 
wound fever, on the other hand, one observes: eleva- 
Peeuson tetpetatutre, derangement of the appe- 
Piee, diecestion,,-and activity of the heart; ema- 
Ciation; psychic derangements, etc. Septic wound 
fever is often followed by septicemia and pyemia. 
(See chapter that treats these subjects). 


TREATMENT.—The main therapeutic problem consists in 
femiocal treatment of the wound. In aseptic 
wound fever it is usually sufficient to change the band- 
age, thoroughly remove the pus, and disinfect 
the wound. The drainage of wounds and incision 
of abscesses produces the same result. 


Septic wound fever, in addition to the above, should be 
treated internally with febrifuges. The most active surgical 
antipyretics (especially with synchronous weakness of the 
heart) are camphor and alcohol, they are best adminis- 
tered in the form of subcutaneous injections of spirits of 
camphor. 


40 SEPTICEMIA 


5. SEPTICEMIA. 


DEFINITION AND CAUSES.—Septicemia (sepsis, 
blood poisoning, putrid fever) isa severe wound infec 
their products of degeneration in the bload, Unlike pyemia, 
it is not accompanied by internal or external local affections 
(metastasis), but by general changes in the structure 
of the internal organs. Thisis especially character- 
ized by swelling of the spleen,and parenchy- 
matousinflammation of the liver, the Kigmey 
the heart, and the other internal O2o ae 
often occurs that septicemia and pyemia are combined (sep- 
tico-pyemia, pyo-septicemia). 


From an etiological standpoint two principal forms of Sep- 
ticemia_ are recognized ; one due tothe action of bacteri a, 
the other to that of chemical poisons (toxins). That 


due to bacteria is termed bacterial septicemia, bac-’ 
teriemia, or septic infection; that which results 
from toxins is naman SETS Tee ation. ‘he former 
may be trangmitted Tssash TiS Bleed esther animals, 
while the blood of the latter is not infectious. Between the 
two there are transitional forms and combinations (mixed in- 
fection). If no cause can be found for the existence of sep- 
ticemia, itis termed cryptogenic Se@ptice ama 

I. Septic infection is caused by several bacteria, 
they may be cocci or bacilli. One can differentiate, therefore, 
between a coccidial and a bacterial septiG@emum 
Some of the cocci which may produce septicemia are the 
streptococcus septicus andthe micrococcus te- 
tragenes; thecocci which produce pyemia, namely, strep- 
tococcus pyogenes and staphylococcus aureus 
are also able to cause septicemia. The experimental inves- 
tigations of Koch have demonstrated the pathogenic action 
of the following bacilli: the so-called bacillus of m'ouse 
septicemia, as well as the bacillus of trate 
Speticemia, the group futher includes thecolon bac- 
illus and the bacillus enteritidis. Sipeciime 


SEPTICEMIA Al 


speticemias, in contrast to the simple forms, may be 
caused by malignant edema, anthrax, blackleg, the organisin 
of erysipelas, and hog cholera, the septic form of so-called foal 
lameness, calf septicemia, septicemia hemorrhagica (wild- 
seuche), chicken cholera, and chicken plague. 


a Septic intoxication is due to the entrance of 
the poisonous product ici bolism. These 


products aretermed toxins, ptomaines, putrid virus, 
cadaver or septic poisons, and meat poisons, 
their chemical structure is extremely variable (toxalbumen ; 
albumoses, organic bases namely, amine and nuclein bases, 
fatty acids, and aromatic products). Usually these toxins are 
absorbed from a purulent focus on the surface of the body, or 
they may be absorbed from the uterus, intestines, lungs, or 
liver. As a rule it is the above named pathogenic bacteria 
that colonize in ichoric wounds, in retained decomposing sec- 
undines (puerpural septicemia), or in ichoric foci in the in- 
testines and lungs, and whose products of metabolsim are re- 
sorbed. Otherorganisms, especially the bacteria of put- 
tefaction, can gain entrance to wounds and pus foci in the 
body. They result in putrid decomposition of animal 
tissues, from which are formed strong chemical poisons, which 
are resorbed and cause general intoxication. ‘That form of 
septicemia _due_to_the products of metabolism of putrefactivg 
bacteria (saprophytes) is termed sapremia. Proteus 
vulgaris andtheclosely allied bacillus celluleformans 
(flesh poisoning) are especially dangerious in this connection. 
Migration of the saprophytes, themselves, to the blood, was 
formerly supposed to be a cause of septicemia ; according to 
recent investigations this appears to occasionally take place. 
PATHOLOGY.—On post mortem examination of animals 
that have died from septicemia, the following conditions are 
noted: The blood is of a tar-like consistence and has the 
appearance of varnish. ‘The blood as well as the solid organs 
of the body manifesta tendency to putrefy. In septic 
infection a microscopic examination of the blood reveals the 
concerned bacteria, which have led to a decomposition 
of the white and red blood-corpuscles, The 


42 SEPTICEMIA 


white blood-corpuscles, in particular, are transformed to form- 
less colonies of bacteria as-a result of the numberless organisms 
that have gained entrance. Asa result of parenchymatous 
disease of the vascular walls, there occurs a hemorrhage 
into the mucous membrane, beneath the serous membranes— 
especially beneath the endocardium—into the mesome- 
trium and omentum, kidneys, spleen, and liver. 

The spleen,liver and kidneys usually show par- 
enchymatous swelling, the heart-muscle, and 
occasionally the skeietal muscles, havea cooked ap- 
pearance. In many cases there also exists an ulcerative 
endocarditis; a catarrhal, hemorrhagic, and even diph- 
theretic enteritis; as well as a parenchymatous and hem- 
orrhagic nephritis. In very acute cases of septicemia 
these changes are not pronounced. This is especially true of 
the toxic form, where, similar to poisoning, post mortem may 
give negative results. (Caution in the inspection of meat !). 

SYMPTOMS.—Septicemia is the most important and the 
most frequent general wound infection disease. It is found in 
the horse after traumatic, pyo-ichoric inflammations of the 
joints (pedal joint, tarsal joint) and the tendon-sheaths, as 
well as in severe septic, subfascial and intermuscular phleg- 
mons. In the cow and bitch septicemia frequently follows 
parturition (puerperal septicemia). Comparatively speak- 
ing, swine are very resistant to septicemia (castration). Ac- 
cording to the seat of origin, the local changes are extremely 
variable. 

1. Septicemia in the horse is characterized by a septic 
phlegmon around the margin of the wound. Sometimes local 
wound changes are absent (peracute cases). The general 
symptoms usually begin with severe febrile indications. 
The temperature may go to 42 C., and over, occasionally it is 
accompanied by chills, the pulse is frequent, small, and 
finally imperceptible, heart weakness is pronounced. 
In many forms of septicemia, elevation of temperature may 
fail. One occasionally observes severe general- symp- 
toms: complete loss of appetite (occasionally horses eat a 
quarter or half ration to within a short time of their death), 


SEPTICEMIA 43 


pronounced emaciation and weakness, heaviness of the 
sensorium, trembling, sometimes paralysis of the posterior 
limbs, profuse and continued perspiration, dirty-red 
or icteric coloration, and echymosis of the mucous 
membranes, discolored, albumenous urine, and towards 
the end, profuse diarrhea with symptoms of colic. 
The duration of the disease is extremely variable ; it may ter- 
minate fatally within twenty-four hours, it usually continues, 
however, several days, and may exist for several weeks (in- 
flammation of the pedal joint). 
een cattle; pucetperalvsepticemi'’a is the most 
frequent form (septic form of puerpural fever). Clinically, 
both forms of septicemia may be recognized ; infection and 
futoxication. »Pterperal infection is characterized, 
either by a puerperal phlegmon, a septic metritis 
(fever, straining, groaning, pain on pressure over the abdo- 
men, stinking, chocolate colored discharge from the uterus, 
diphtheretic changes on post mortem); or by an acute 
puerperal septicemia, which is differentiated from 
the preceding by general septic conditions (sudden loss of ap- 
petite and lacteal secretions, high fever, yellow mucous mem- 
branes, and weakness). As a rule it leads to death in from 
one to three days, and the post mortem changes are frequently 
Siieituor imperceptibie. Puerperal intoxication ex- 
ists, either in the form of a parturient paresis (para- 
lytic calf fever, auto-intoxication ), or slight symptoms of dis- 
ease (weakness, gastric derangement, normal temperature). 
Retention of the after-birth, especially, is a cause 
of a mild form of sapremia; sudden paralytic conditions 
with death after a few hours are rare (De Bruin). 
TREATMENT.—As in a wound-fever, so in septicemia, 
focal antiseptic treatment of the wound is’ of 
greatest importance. Apply powerful disinfectants, carefully 
remove stagnated wound-secretions, give thorough drainage, 
incise early all fluctuating spots. A puerperal uterus should 
be thoroughly irrigated and any retained placentae removed. 
The internal administration of febrifuges is of secondary im- 
portance. Those agents which have been of greatest service 


44 PYEMIA 


are: camphor, alcohol, and quinine. Argeneie 
colloidale as wellas quicksilver in the form of small 
doses of calomel are employed internally. Antistrepto- 
coccic serum, on the other hand, has not proved satisfactory. 


6. PYEMIA. 


DEFINITION AND CAUSES.—Pyemia is a general wound- 
infection disease ; in contrast to septicemia it is characterized 
by the formation of suppurative foci of disease in 
the body (metastases). TThe bacteria of pyemaa 
are essentially those of septicemia. The most 
frequent causes of pyemia are pus-coccl, especially, 
staphylococcus pyogenes aureus, and strepto- 
coccus pyogenes. ‘These are found in any abscess, and 
are the ones usually involved in metastasis (staphylomycosis 
niultiplex, staphylohemia, pyemia metastatica). They enter 
the blood from a primary pus-focus, colonize in the various 
internal organs, where they multiply and cause suppuration. 
An acute or chronic pyemia depends on whether the pus 
cocci enter the blood stream suddenly, and in large numbers ; 
or gradually, and in small numbers. In general, pyemia is 
much less common than septicemia. In the horse it is usually 
the result of a septic, degenerating thrombo- 
phlebitis arising from wounds of the hoof, umbilicus, of 
the jugular vein, following injuries of the bone as well as from 
resorption of internal pus-foci (strangles). Pyemia of foals 
and calves which develops from a suppurative thrombo- 
phlebitis of the umbilical cord (pyemic form of the so-called 
foal lameness or calf lameness) is of practical importance ; 
these diseases possess no bacteriological individualities, in foal 
lameness, especially, staphylococci as well as streptococci have 
been demonstrated as a cause of the disease; in calf lameness 
the colon bacillus has been recognized. In cattle, pyemia 
usually develops from the internal organs, especially from the 
uterus (pyemic form of puerperperal fever), when it originates 
from a suppurative thrombo-phlebitis of the uterine veins, it 
seldom results from traumatic gastritis. Strangles 
in the horse isa specific type of pyemia; the same istrue 


PYHMIA 45 


of so-called dog distemper (suppurative folliculitis of the lips 
with secondary lymphangitis, lymphadenitis, and metastatic 
formations). - Occasionally the origin of pyemia cannot be 
determined (cryptogenic pyemia). 

In many cases it is impossible to distinguish between sep- 
ticemia and pyemia,they both exist at the same time; one 
then speaks of a pyo-cepticemia. From a standpoint 
of practical surgery it is essential, however, to differentiate 
between cases of pure pyemia and septicemia. 

PATHOLOGY.——The anatomical characteristics of pyemia 
are a greater or lesser number of suppurative inflam- 
matory foci (metastatic processes) inthe internal and 
external organs (lungs, liver, spleen, kidneys, brain, heart, 
skeletal muscle, joints, tendon-sheaths, etc.). In foal lame- 
ness, suppurative inflammation of the synovial tissues of 
the joints is the main characteristic (polyarthritis pyemica). 
One also observes, suppurative inflammation of 
other serous membranes, the peritoneum, the pleura, the 
meninges; as well as suppurative inflammation of the eye 
(suppurative choroiditis and panophthalmia). Occasionally, 
one also observes, as in septicemia, an ulcerative endo- 
carditis and numerous circumscribed hemorrhages on 
the serous membranes, in the skin, in the eyes, and in the mus- 
cles. Anatomical changes characteristic of septicemia may also 
be present (Septico-pyemia). Finally, the local changes 
are sometimes very characteristic ; forexample, asa result of the 
colonization of numerous bacteria in the venous walls of the 
wound (umbilical wound), there occurs a suppurative inflam- 
mation of the vascular walls with suppurative degeneration of 
the organized thrombus (suppurative thrombo-phle- 
bitis). This forms a source of the suppurative embolic foci 
within the body, as well as a point of origin for many bacteria 
that are present in the blood and inner organs (micrococci). 

Symproms.—Pyemic wound infection is ushered in with 
meworvine  treqitentivy intermittent,’ very “1r- 
regular fever, and occasionally with chills. After this 
there develop symptoms of metastatic inflammation 
of the lungs, or symptomsof abscess formation in 


46 THE REMAINING WOUND INFECTION DISHASES 


the liver, kidneys, or brain, pyemic) potgua. 
thritis, tendovaginitis,, pleuritis, méenimeagaee 
etc. Occasionally, one further observes multiple, sub- 
cutaneous pus-foci, which often develop suddenly in 
large numbers in the form of phlegmonous swellings in 
various parts of the body. Pyemia usually runs a longer 
course than septicemia; usually from a few days to a few 
weeks, depending on the seat and course of the metastasis. 
It may develop into a chronic pyemia with pronounced 
emaciation of the animal. Recovery is more frequent than in 
septicemia, although it 1s uncommon, and convalesence oc- 
curs only after a long time. 

Puerperal pyemia (pyemic form of puerperal 
fever) is characterized by a febrile polyarthritis on the 
carpal and tarsal joints, mastitis, osteomyelitis, 
and tendovaginitis of the flexor tendons, as well as 
chronic parametritis (multiple abscess in the pelvic 
counnective tissue, chronic emaciation). It occurs in cattle, 
but is rare in horses. 

Strangles-pyemia (so-called wandering strangles) 
develops principally in the form of abscesses of the lymph 
glands in various parts of the body (superior, middle, in- 
ferior cervical glands, axillary glands, bronchial glands, omen- 
tal glands, pubic glands, lumbar glands, popliteal glands) as 
well as abscess formation in the brain, spinal marrow, 
omenttm, udder, kidneys, pancreas, orbitete 

TREATMENT.—AsS in septicemia, the principal treatment 
consists in careful local disinfection, drainage, and 
incision. On account of its specific action as a febrifuge, 
quinine may be tried. 


7. THE REMAINING WOUND INFECTION DISEASES 


ERVSIPELAS.—In man, this disease is a specific, infectious 
inflammation of the skin and subcutem; it involves the 
rete Malpighi and the papillary bodies. Through the medium of the 
lymph stream it rapidly spreads over large areas of the skin, and 
leads to severe general infection; the local changes, 
however, are usually slight. A superficial wound is usually the point of 
origin of the infection. The bacteriological investigations with 


THE REMAINING WOUND INFECTION DISKASES 47 


reference to the bacteria which cause erysipelas are very contradictory. 
It was formerly thought to be entirely due to the streptococcus 
erysipelatis, aspecific organism discovered by Fehleisen. Ac- 
cording to recent investigations (Baumgarten, Fraenkel, and others), 
the specific action of the coccus of erysipelas, on the other hand, is very 
doubtful; this organism appears to be identical with streptococcus 
pyogenes. The theory has been advanced, therefore, that erysipelas 
is not a specific wound infection disease, buta localized form of 
septicemia in the skin. According to its virulence, each strep- 
tococcus may cause suppuration, erysipelas, phlegmon, abscess forma. 
tion, pyemia, and septicemia (Marmorek). It is also claimed that 
erysipelas may be caused by staphylococci and typhus- 
bacilli. In man, therefore, according to the etiology, two forms of 
erysipelas are recognized: the primary, genuine type, due to strep- 
tococci ; and the secondary type, which occurs during the course of 
various infectious diseases. 

The symptoms of erysipelas in man consist in the appearance 
of a diffuse red swelling in the vicinity of the wound; the swelling 
spreads very rapidly, and frequently along the course of the lymph 
streams (migrant erysipelas, ambulant erysipelas.) In other cases new 
inflammatory foci arise in several distant places, they are manifestly 
metastatic (erysipelas multiplex). Corresponding to the extension of 
the erysipelas, there is observed a rapidly developing, high grade 
fever. As the result of an active serous exudation, blisters are formed 
in many places on the surface of the skin (erysipelas bullosum). As a 
rule, the erysipelas heals with rapid sinking of the fever and desquama- 
tion of the skin. In typical cases the healing is as rapid as the develop- 
ment (simple, typical, non-complicated erysipelas). In other cases 
phlegmonous and gangrenous processes are present (erysipelas phleg- 
monosum and gangrenosum). Other complications are: erysipelatous 
pneumonia, pleuritis, endocarditis, pericarditis, myocarditis, diphtheria 
of the pharyngeal mucous membranes, enteritis, intestinal ulcers, 
nephritis, inflammation of the brain, neuritis, peripheral paralysis of the 
herves, suppurative panophthalmia, otitis, parotitis, as well as septicae- 
mia, and pyaemia. In individual cases it has been observed that new 
formations (carcinoma, sarcoma, lymphoma, lupus) disappear after an 
accidental infection with erysipelas. Based on this experience, the un- 
safe experiment has been made of artificially producing erysipelas on 
the new formations mentioned by means of injections of erysipelatous 
cocci; the object being, to cause healing (erysipelas inoculation, cura- 
tive, artificial erysipelas). Treatment of erysipelas consists in epi- 
dermatic and endermatic (parenchymatous) applications of disinfectants 
(carbolic acid, creosote, creolin, lysol, tar, ichthyol, tincture of iodine, 
sublimate), incisions of the skin, with antiseptic irrigation, application 
of pressure to the healthy margins (collodion, strips of sticking-plaster), 

. 


e 


48 THE REMAINING WOUND INFECTION DISEASES 


as wellascold. Recently the antistreptococcic serum has been applied. 
The fever is treated with camphor. 

Concerning the OCCURRENCE OF ERYSIPELAS IN ANIMALS def- 
inite knowledge is scarce. This is partly due to the fact, that the 
most characteristic symptom, the redness of the skin, is wanting in 
animals on account of the pigment formation and hair. On the other 
hand, genuine, typical erysipelas appears to be much 
less common in domestic animals than in man. For 
this and other reasons, it is better not to use the word erysipelas in vet- 
erinary surgery, but in general, to speak of inflammatory edema. 
In CATTLE, “‘erysipelas of the udder,’’ an erysipelatous, in- 
fections inflammation of the skin, is seen in the udder before and after 
parturition. The skin, on the posterior quarters of the udder in partic- 
ular, and occasionally on the inner surface of the tibia, is very red, 
painful, and swollen. It is alleged that this affection is frequently 
complicated with phlegmons of the subcutem, and either leads to 
desquamation and healing, or permanent schlerosis of the skin. A fatal 
termination is never observed. In the HORSE, phlegmon of the poster- 
ior limbs is considered erysipelas by many; Kitt, for example, 
defines it asa dermatitis erysipelatosa, while Schindelka classifies 
it with the phlegmons. It is very questionable if the so-called erysip- 
elatous form of scratches is genuine erysipelas. Malzew (Zur Aetio- 
logie der Mauke. Inaugeral-Disseration. Dorpat, 1899) sustains the 
theory, that with few exceptions, those inflammations of the fetlock 
region, known as scratches, are genuine erysipelas. In scratches of the 
horse he claimed to have found regular streptococci, which were identi- 
cal with those of erysipelas. Also, according to his experiments, 
erysipelas could be successfully transmitted from man and dog to the 
skin on the fetlock region of the horse. Considered from the stand- 
point ; that specific erysipelatous cocci do not exist (see above); that 
these cocci are found much more often in non-erysipelatous, simple, 
suppurative inflammations of the skin; that the disease is neither gen- 
eral, nor has a tendency to spread ; the erysipelatous nature of scratches 
is not a well supported fact. On the other hand, perhaps the case 
described by Semmer (Oesterreichische Monatshefte. 1895, $289) was 
one of genuine erysipelas. Three horses showed swelling of the lips 
after transportation in severe cold ; this spread rapidly to the region of 
the cheeks, the pharynx, the throat, and the anterior part of the thorax. 
All three horses died after a short time. Post mortem examinations 
revealed the following condition: an exudate in the swollen portions of 
the skin that was sero-fibrinous, partly fluid, and partly gelatinous in 
character; the pleura, pericardium, and peritoneum presented hemor- 
rhagic inflammations ; in the thoracic and abdominal cavities, as well as 
in the pericardial cavity, there was an abundance of dirty-red fluid ; on 
the omentum, and under the pleura of the lungs, there was anabundant 


MALIGNANT EDEMA AQ 


extravasate of hlood; the spleen was enlarged. A pure culture of 
staphylococci were secured from the serous exudate of the swollen skin. 
Experimental cutaneous and subcutaneous injections of these in horses 
resulted in large, erysipelatous swellings at the point of injection 
(shoulder), which spread downwards to the carpus; fever and loss of 
appetite were also noted. In DoGs, among 70,000 cases of disease, I 
have observed symptoms referable to erysipelas in only four cases; I 
have described one case in the Wochenschrift fur Tierheilkunde (1894). 
Schindelka’s (Hautkrankheiten. 1903) experiences are identical 
with mine ; he has observed only three cases of erysipelas in the dog. 
Moller, also, (Lehrbuch der Chirurgie. 1893) has only occasionally 
observed typical erysipelasin the dog. In SwINEs, on the other hand, 
erysipelas is much more common inthe form of erysipelas of the head ; 
it may also be transmitted by inoculation to other swine (Fehlei- 
sen). Nothing definite is known concerning genuine erysipelas in 
sheep, cats, and birds. 


MALIGNANT EDEMA.—Malignant edema is a specific phleg- 
mon: it may be termeda sero-hemorrhagic infiltration of 
cellular tissue with gas formation. Apparently, the cause of the 
disease may be due to several bacteria. The most important is the 
malignant edema bacillus (bacillus edematis maligni) dis- 
covered by Koch. fThe bacilli of malignant edema form spores ; 
they are very motile; liquefy gelatine; take Gram’s stain ; they 
are anaerobic rods 3 to 5 micro-millimeters in length, and one 
mirco-millimeter broad; they are four times as long as broad and a 
trifle slimmer than the anthrax bacillus. } Several rods become adherent 
to form threads to-40 micro-millimeters in length. After the 
death of the animal the edema bacilli increase rap- 
idly in length, and form threads which are partly 
straight, partly curved, and partly twisted; they are 
arranged in such a manner as to give one the impression of bacilli 
arranged upon one anotherin rows. Spores are afterwards formed from 
these threads. In cadavers of asphyxiated individuals that have been 
kept for 24 hours at a temperature of 38° C, large numbers of malignant 
edema bacilli are found in the blood, especially in that of the portal 
vein (migration from the intestines). By the same method, the so- 
called cadaver-bacilli are constant in the blood of the liver and 
in the spleen after 12-24 hours, in the general circulation of 
our domestic animal cadavers soon after, as the result of 
death due to dyspnea, especially from colics, when they remain] un- 
opened for some time in a warm place (confusion with anthrax bacil- 
lus!). There are also various forms of pseudo-edema bacilli 
(earth bacilli). 


The edema bacillusis extremely abundant in nature. It 
is especially numerous in the upper layers of the earth. If a small 


50 MALIGNANT EDEMA 


amount of ordinary garden soil is brought beneath the skin of a rabbit, 


the animal dies from malignant edema in from 24-36 hours. The spores 
of malignant edema are also found in horses that are entirely normal, in 
the saliva and in the feces, so that infection may readily occur in 
the oral cavity and in the vicinity of the anus. For this reason, infec- 
tions are very common in the vagina and in the puerperal 
uterus. The infection results from an unclean condi- 
tion of wounds of the skin or mucous membrane; and 
may be conveyed by means of soil, feces, saliva, dust, 
etc.,it depends, however, on the entrance of the edema 
bacillu into the subcutaneous or submucous con- 
nective issue. The entrance of this organism into the circu- 
lating blood is comparatively harmless because the oxygen of the 
blood is fatal to anaerobic bacteria. Inoculation of the 
cutis also, produces no results (oxygen of theair). It isalso 
difficult for the bacilli to enter granulating wounds. Moreover, the 
subcutaneous and submucous connective tissue must be previously 
weakened by means of previous contusions, the entrance of foreign 
bodies, ulceration, etc., before the edema bacilli gain entrance. This 
depends, first, on the existence of a nourishing media for the bacilli 
(serum, lymph, blood). Then the infectious material must be as free 
as possible from the oxygenated blood, as the oxygen of the blood is 
fatal to the bacilli. The greater the interruption of the circu- 
lation in the infected area, the more favorable are the conditions for 
the growth of the edema bacillus. According to recent investigation 
(Besson), genuine spores of the edema bacillus cannot develop in the 
healthy tissues of living animals (phagocytosis). Their development 
much more dependent on association with other bacteria 
(microbes favorisants) especially with staphylococci. This condition 
explains, as in tetanus, that, regardless of the frequency of the occurrence 
of the edema bacillus (ubiquity), cases of sickness from malignant © 
edema are relatively uncommon in animals. | 

Since Kitt has demonstrated that malignant edema could be ex- 
perimentally transmitted to domestic animals, numerous cases have been 
observed in cattle, horses, and sheep (Jenson and Sand, Reuter, 
Attinger, Elmenhoff, Nielson, Friis, Mesnard, Besson, Horne, de Bruin, 
Willach, Albrecht, Kitt, Gilruth, Reakes, personal observations). The 
causes are due to injuries, for example, subcutaneous injections of 
eserine, injuries of the tongue by means of food, foreign bodies, bites, 
and perforating wounds; injuriesto the uterus, the vagina, and the vulva 
(so-called puerperal blackleg which may also be caused by the pseudo- 
edema bacillus and the genuine blackleg bacillus), operations with un- 
clean instruments, castration of sheep and goats, amputation of the tail. - 
In the Province of Brandenburg, in 1897, from 600 freshly shorn sheep, 
50 died from malignant edema (Lembcken); in New Zealand, in Igoo, 


TETANUS 51 


among 4,000 shorn sheep, 300 died from malignant edema. In one case 
in a horse, I observed a twelve-hour period of incubation. Obviously, 
malignant edema has been known for a long time in veterinary science, 
but under other names (flying necrosis, black necrosis, fire, progressive 
cellular inflammation), and formerly as blackleg, sometimes as anthrax 
and erysipelas, as well as wildseuche and cattle plague. 

The symptoms of malignant edema consist of a swelling in 
the vicinity of the point of infection. This develops. 
suddenly, is edematous, doughy,and very sensitive; it 
spreads rapidly to the neighboring tissues, and fre- 
quently crackles on palpation. The favorite seats of the 
edematous swellings are in the following places: the tongue, pharynx, 
laryngeal and parotid regions, the head, throat, and upper limbs, the 
lumbar and sacral regions. The center of the swelling is usually cool, 
relaxed and painless ; while the periphery is tense, hot, and sensitive. 
The subcutaneous and submucous connective and 
fatty tissue, as well as the neighboring muscular 
tissue, is filled with a gelatinous exudate, and a foul 
smelling gas. The yellowish-red edematous fluid contains 
many characteristic edema bacilli and threads, which are not 
present in the blood during life, and are only occasionally found 
in the blood after death. In many cases, however, the local symptoms 
are absent. One also notes high grade dyspnea (edema of the lungs), 
as well as severe gastric derangements (infammation of the mucous 
membrane). The disease usually runs its course in a short time (one 
to three days), terminating fatally with severe febrile symptoms. 
When the disease is confined to the head, recovery sometimes occurs. 
On post mortem the spleen, liver, and kidneys are usually intact ; 
splenic tumors, in particular, are occasionally absent. 

The treatment, as inphlegmons, consists in making free incis- 
ions—admit the air—the most active opponent of anaerobic bacilli ; 
provide drainage and apply antiseptics. According to an observa. 
tion of Attinger, warm fomentations appear to be contra-indicated ; 
they favour the extension of the edema. With reference to the liter- 
ature on malignant edema Cf: Friedberger and Frohner, ‘‘Spec- 
ial Pathology and Therapeutics’’. Sixth Hdition, 1904. Vol.,II. Also 
Kitt: Monatshefte fur praktische Tierheilkunde. Bd. VIII. 

TETANUS.—This was formerly considered a disease of the nerves 
characterized by trismus. As a result of the investigations of 
Nikolaier and Kitasato it was found to bea genuine wound- 
infection disease, caused by the bacillus of tetanus. 
It is most frequently observed in the horse after injuries to the hoof 
(nail pricks, nailing, treads on the coronet), the posterior limbs and the 
head, after castrations, after operations on the tail (amputation, setting 
up), subcutaneous injections, removal of setons, entrance of foreign 
bodies (kernels of grain) into the guttural pouches. It is also observed 


52 TETANUS 


in cattle (tetanus puerperalis after injuries to the vagina and uterus, 
castration, umbilical wounds in calves), sheep and goats (castra- 
tion, inoculation, seton, umbilical wounds). In dogs, however, 
tetanus is extremely rare ; two cases have been observed by MOller. 
Among 70,000 diseased dogs, I have never seen a case of tetanus; the 
experimental inoculations of garden soil into dogs by Nikolaier also 
gave negative results. Kitt, on the other hand, was able to produce 
tetanus in dogs by injecting pure cultures. 

The tetanus bacillus (bacillus tetani) is in the form ofa rod, 
shaped like a stick pin, music note, or cooking ladle ; the end contains 
a spore. It is found everywhere, especially in garden soil, as well as 
in earth that has been covered with horse manure, it is also 
found on the floors of horse stalls. As experimental inoculations 
with ordinary garden soil have proved, infection usually re- 
sults from the entrance of bacterial earth; other ob- 
jects may act as intermediate carriers of the tetanus bacillus (horse-shoe 
nails, splinters of wood, instruments, dust of hay, manure, kernels of 
grain, cob webs). Conditions for the infection are made more favora- 
ble by the simultaneous existence of other microorganisms, especially 
the pus-forming bacteria (microbes favorisants). In contrast to the 
bacteria of septicemia and pyemia, the tetanus bacilli do not enter the 
blood, but remain at the point of infection where they develop a 
strychnine-like toxin (tetanotox-albumen), which is resorbed 
by the blood. Inthe form of tetanospasmin it produces convulsions as 
a result of its action on the spinal marrow. This toxin contains an un- 
precedented poisonous; a dose of 0.00025 grams, equal to 4% mg., equal 
to I-200 of a minum, produces death in the horse ; it is a thousand times 
more poison than strychnine (lethal dose for the horse—o.25 grams). 
The toxin is absorbed by the substance of the axis cylinders of the peri- 
pheral nerves and carried to the central nervous system. Tetanus, 
therefore, is to be considered as an infectious disease, in which a general 
intoxication arises from the local point of infection. Occasionally one 
observes a seemingly long period of incubation, several days 
or even weeks (the usual period is from 4-20 days), in which tetanus 
occurs, for example, after careful disinfection and bandaging of the 
wound, even after healing and cicatrization are complete. I have ob- 
served a period of incubation of even forty days in a horse (Monatshefte 
fiir praktische Tierheilkunde. 1902). 

The symptoms of tetanus consist in locking of the jaws (tris- 
mus) ; convulsive, stiff extension of the head, throat, and back (ortho- 
tonus); dorsal or lateral curvature of the throat (opisthotonus and 
pleurotonus) ; stilted, or sawbuck-like position of the limbs; stiff, 
extended position of the tail and ears ; pronounced contraction of the 
compressors of the abdomen ; Pe opieen (spasms of the inspiratory mus- 
cles); increased reflex irritability ; timidity; and perspiration. In 
horses, the course is either very rapid (death after one to three 


WOUND DIPHTHERIA 53 


days), or acute. (death after four to ten days); in other cases, espec- 
ially in the non-frequent cases of recovery, a subacute and even a 
chronic course is observed (many weeks). One occasionally observes a 
contagious-like outbreak of tetanus (experience with military horses 
and in clinics). The mortality in horses is from 50-80%. The 
post mortem is apparently negative. Treatment is not very 
satisfactory (local disinfection ; removal of the foci of infection, ampu- 
tation of the tail, forexample; removal of external excitants; diate- 
tics). Administration of chloral hydrate, bromide of potash, morphine. 
The treatment of horses suffering from tetanus with tetanus antitoxin 
has not proved satisfactory. Antitoxin, on the other hand, has proven 
useful as prophylactic previous to operations (Nocard, Labat). With 
reference to the literature on tetanus see: Friedberger and 
Frohner, ‘Special Pathology’’. Sixth Ed. 1904, Vol. II. 

WouND DIPHTHERIA.—The name wound diphtheria (hospital gan- 
grene, gangrena nosocomialis) indicates a wound infection disease 
which was formerly very common, but which has become infrequent 
under the influence of modern antiseptics. It consisted of a coagu- 
lation necrosis of the granulations asa result of the action 
of specific bacteria (necrosis bacillus). The granulations are trans- 
formed into a yellowish-red, suppurative, ichorous pulp (croupous and 
diphtheritic form) ; or into a grey, pulpy, gangrenous mass (ulcerative 
form) ; or intoa stinking, putrid and soft mass similar to the pulp of a 
spleen (pulpy form). Treatment consists of burning early, or cauteri- 
zation of the wound with chloride of zinc. Bayer has described a case 
in the horse. The tissue in the region of the parotid glands was trans- 
formed into a greenish-brown, fetid mass; the process was accompa- 
nied with the formation of the gasses of degeneration, which had pro- 
duced an emphysematous condition of the neighboring tissues. I have 
observed similar cases in the horse. 

GLANDERS.—In rare cases, wounds in the horse become infected 
with the bacillus of glanders (primary glanders.of the skin). This 
occurs, especially, on the extremities, abdomen, thorax, shoulders, and 
head. There then develops from the wound, a crater-hke glanders 
ulcer; it is characterized by tenacious, discolored, frequently hemor- 
rhagicsecretions; from the ulcer, wreath-like swollen lymph vessels 
extend to lymph glands which are also swollen (glandular lymphangitis 
and lymphadenitis). Lameness exists according to the location of the 
glandular processes. Occasionally there also develops a chronic 
glandular phlegmoun, which may finally leadto elephantiasis 
of the extremities and head (glandular pachyderma). I have described 
one case of this kind in the horse (Report 1883). Richter has 
described acase of glanders of the eye (glandular keratitis) (Zeit- 
schrift fur Veterinaerkunde. 1896). For further information concerning 
glanders, especially with reference to differential diagnosis of the same, 
refer to text-books on special pathology. 


54 RABIES 


RABIES.—Rabies is a genuine wound infection disease ; the cause 
of the infection has not yet been discovered ; infection gains entrance 
from the saliva through the medium of wounds caused by bites, 
and then passes into the body. The bites, themselves, present no 
special characteristics, as a rule they heal similar to the wounds of 
tetanus. The acquired virus is sufficient for the development of the 
disease, the appearance of the first visible symptoms may require 
weeks, and even months (long period of incubation). According 
to paragraph 35 of the government laws which refer to animal plagues, 
no attempts can be made to cure animals affected, or supposed to be 
affected, with rabies; animals affected with rabies must be killed 
immediately (paragraph 37); those supposed to be affected must be 
killed or confined (paragraph!34). In man, treatment consists in cauter- 
ization, cutting out the wound, as well as in the application of strong 
disinfectants (sublimate, creolin, aqua chlorata, calcium permanganate, 
etc., carbolic acid is unefficient). 

BLACKLEG.—This is also a wound infection disease in which the 
blackleg bacillus gains entrance to the wound only through inju- 
ries to the skin and mucous membranes (the subcutis and submucosa). 
Blackleg, therefore, may be considered as a specific phlegmon 
of cattle, similar to malignant edema. It is characterized by edema- 
tous swellings of the skin which develop rapidly and crepitate, the cen- 
ters of these swellings undergo necrotic degeneration, they are 
located on the upper parts of the limbs, the throat, the shoulders, the 
inferior surface of the thorax, etc., the motions of the animal are also 
deranged ; there are swellings in the regional lymph glands; severe 
general symptoms, and high fever are present. The course of the dis- 
ease is usually rapid, terminating fatally in from one to three days. 
Treatment of the area of infection is usually too late (incision, disinfec- 
tion amputation, ligature). The so-called puerperal blackleg 
of cattle is usually, not a case of genuine blackleg, but partly a gas. 
phlegmon, partly a malignant edema (Carl); sporadic cases of genuine 
puerperal blackleg have been identified by Rievel, Olt, and. 
Ostertag. For further information concerning blackleg see text- 
books on special pathology, as well as Kitt, Monatshefte fur praktische 
Tierhielkunde. VIII. 

ANTHRAX.—In contrast to man, anthrax is rarely a wound infection 
disease in animals. In addition to the ordinary infection through the 
intestines, one occasionally observes sporadic cases of entrance of 
anthrax bacilli through wounds in the skin and mucous mem- 
branes, after previous operations (castration), bites, or punctures from 
insects. There exists, first, a local inflammatory focus in the skin and 
mucous membranes (anthrax carbuncle, anthrax edema) 
this is followed by a rapid general infection, which usually has. 
a fatal termination. Cases of anthrax of the skin and mucous mem- 
branes were formerly described under the names, carbuncle disease, boil 


TREATMENT OF WOUNDS 55 


fever, anthrax- of the tongue, anthrax of the gums, and morbus 
carbuncularis. 

WILDSEUCHE.—The so-called exanthematic form of wildseuche 
exists apparently through the entrance of infectious material into small 
wounds of the skin or mucous membranes (injuries from the twitch, 
accidental injuries), and is, therefore, considered a wound infection 
disease. It is characterized by pronounced edematous swelling of the 
skin and mucous membrane, as well as the subcutis and submucosa of 
the head, the oral cavity, the submaxillary region, throat, etc., there 
also develop symptoms of septicemia hemorrhagica. Death usually 
occurs after 12-36 hours. Details concerning wildseuche may be found 
in text-books on special pathology. 

STRANGLES.—Strangles usually develops from the mucous mem- 
branes of the respiratory and digestive apparatus. Occasionally there 
occurs a strangles infection from wounds, whereby the 
regional lymph glands are involved first. A case of this type has been 
described by Litfas (Berliner tierarztliche Wochenschrift. 1895). I, 
myself, have observed two cases. 

With reference to other wound infection diseases (actinomy- 
cosis, botryomycosis, tuberculosis, lymphangitis, 
phlebitis, petechial fever) compare with the chapters on these 
subjects. 

WOUND INFECTION DISEASES OF THE VETERINARIAN.—The fol- 
lowing are the various wound infection diseases against which the vet- 
erinarian should be guarded: phlegmons, lymphangitis, and 
erysipelas, septicemia and pyemia, eczema on the 
hands and arms (obstetrics), anthrax, glanders, ra- 
bies, botryomycosis, tuberculosis. Among 365 officials 
in the Berlin Abbatoir and Stock Yards (veterinarians, butchers, etc.), 7 
had inoculations with tuberculosis on the hands, 3 had questionable 
nodules (Lassar), 


VI. TREATMENT OF WOUNDS. 


ANTISEPTIC AND ASEPTIC TREATMFNT OF WOUNDS.— 
Lister is the founder of the modern treatment of wounds. 
Working on the theory that wound infection might be pre- 
vented by the application of antiseptics, as well as careful 
bandaging, he employed, in 1867, carbolic acid with a band- 
age ; the latter being termed a Lister Bandage. This Lister 
bandage is applied as follows: irrigate the wound with a 
2-5% solution of carbolic acid; spray the surrounding air 


56 TREATMENT OF WOUNDS 


with the same solution ; cover the wound with a piece of 
carbolized silk or surgeons cotton (silk or cotton protective) ; 
place over this a thick layer of carbolized gauze or other car- 
bolized dressing ; over this is placed an impermeable layer of 
surgeons cotton (mackintosh ); the whole is retained by means 
of a moist, carbolized gauze bandage. Between the years 
1872-1875 the Lister bandage was in general use in Germany. 
Later the use of the spray was dropped and the simple bandage 
applied. In 1880 the dry iodoform pack supplanted the use 
of the carbolic acid. Since then, other disinfectants have 
partially taken the place of iodoform (sublimate, creolin, lysol, 
tannoform, and other disinfectants). 

In recent times the use of antiseptics in human surgery 
has been restricted, in some cases even suspended. Schim- 
melbusch and others claim that when a wound has been 
infected for no longer than one minute there is no certainty of 
destroying the bacteria with disinfectants. There is no ob- 
ject, then, in disinfecting the wound, it is even harmful, 
because the tissues are irritated and the wound secretions are 
increased. Antiseptic treatment has, therefore, given way 
to the aseptic method, whichis carried out as follows: the 
wound is made as dry as possible with the use of a sterilized 
towel, and without the application of antiseptic fluids; it is 
irrigated only with sterilized water, or sterilized physiological 
salt solution (0.6%), and then covered with a sterilized bandage. 
The material is sterilized in a specially prepared apparatus, it is 
exposed to steam of not less than 100° C., for a period of 
twenty to thirty minutes ; the instruments are sterilized in the 
same manner. Boiling for a long time in a one or two per 
cent soda solution is one of the surest methods of sterilization. 
Special care is taken with reference to disinfection of the hands 
of the operator. After the dirt has been thoroughly removed — 
from the nails, the hands are brushed with soap and water, 
then washed in warm sublimate, carbolic, or creolin water, and 
finally rubbed in a fifty per cent alcoholic, or alcohol and soap 
solution. The following must also be rendered aseptic: the 
operating field, operating table, clothing of the patient, oper- 
ators, assistants and helpers, all utensils that are used, as well 


ANTISEPTICS mi 


as the operating field in the vicinity of the wound. Even 
operating gloves, and masks for the mouth and nose are em- 
ployed as aseptic protectives. 

The aseptic treatment of wounds in human surgery 
has many advantages. Healing follows the natural self-pro- 
tection of the tissues (leucocytes, blood-serum), and there are 
only slight changes from external interference. Recently, 
many surgeons have changed from the purely aseptic method 
to the antiseptic; since Henle and others, contrary to the 
conclusions of Schimmelbusch, have demonstrated by means of 
statistics that local disinfection of the wound is possible within 
the first few hours, and that the results of the aseptic method 
are no nmiore satisfactory than those of the antiseptic. Bruns 
even employed pure carbolic acid to disinfect the wounds, 
Kuster used the hot iron (Berlin Surgical Congress, tgor). 
Antiseptic surgery involves the very difficult, or impossible, 
disinfection of the hands, which is not improved by the use of 
sterilized operating gloves (Berlin Surgical Congress, 1898). 

Ueto timemmpesent time ‘aseptic surgery in 
veterinary science has received a very lim- 
ited use. I have already mentioned this fact in the first 
edition of this book. The veterinarian deals mostly with old, 
infected wounds, in which, not asepsis, but thorough antisep- 
sis, is necessary. Even fresh operation wounds can seldom 
be given aseptic treatment, for example, in a clinic. Even 
in a well equipped veterinary hospital the aseptic surgical 
treatment of horses offers the greatest difficulties. Bandages 
can be applied only to a limited extent, in some cases it is 
almost impossible to prevent infection during the operation. 
When compared with human surgery, infection through the 
air plays a more important part (dust, hair), against 
which asepsis is of no use. For these reasons, the 
ma@eseptic method’ is tobe preferred ito the 
femenvic in veterinary science. 

ANTISEPTICS.—In selecting and deciding upon the various 
therapeutic agents to be used in the treatment of wounds, a 
general point of view comes into consideration. In the first 
place, besides the disinfecting properties of the various ma- 


4 


58 ANTISEPTICS 


terials, we must consider the resistance of the organisms in the 
wound. ‘This resistance lies, as I have fully explained else- 
where (Lehrbuch der allegemeinen Therapie), about midway 
between the very resistant anthrax spores, and blackleg bacilli 
atone extreme ; and the easily destroyed anthrax and swine 
erysipelas bacilli at the other. The streptococci and 
staphylococci, especially,should not be fought 
with weak disinfectants; their destruction re- 
quires stronger antiseptics: (sublimategpages 
lin, lysol, tannoform, carbolic: acid, *so@ummumam 
of aluminum acetate, nitrate of silvers. 
toxic action of the antiseptics must also be considered, their 
irritating action on the wound, their decomposition by the 
secretions of the wound, their strength and form, the price, 
and the state of healing. In general the following rule should 
be adopted: employ disinfectants which are ac 
tive, not too irritating, noteasily decomposed, 
non-poisonous, reasonably active in aqueous 
solution, prompt in their action on the wouua 
(tannoform). Actual disinfection should be. preceded by 
careful irrigation. The following descriptions refer 
to the more important disinfectants (detailed descriptions are 
found in my Lehrbuch der Arzneimitellehre, 6. Aufl. ). 


SUBLIMATE.—This is our most powerful and poisonous dis- 
infectant. A I-1o0oo sublimate solution quickly destroys 
all bacteria involved in wound infection. With the ex- 
ception of ruminants it can be employed on all domestic animals. In 
cattle sublimate acts as a specific poison, for this reason 
one must be guarded in its use. When combined with albumenous 
wound secretions it partly precipitates in the form of an albumenate of 
mercury, partly decomposes (formation of oxychloride of mercury). 
The decomposition has no material influence on its antiseptic action ; 
decomposition may be prevented by the addition of sodium chloride 
(pastil of sublimate). The advantages of sublimate are: its strong 
antiseptic properties, non-odor, cost, convenience (sublimate tablets). 
The disadvantages of sublimate are: pronounced toxicity, espe- 
cially for cattle ; irritability, especially on the mucous membranes of 
the eye (ophthalmology), and the uterus (obstetrics); it also rapidly 
amalgamates the instrumeuts. In France,in the place of sublimate, 
hydrargyrum biniodidum rubrum is employed ina solution of 


ANTISEPTICS 59 


I: 10,000 to I + 20,000; it is more active and less irritating. Many also 
prefer hydrargyrun cyanatun to sublimate because it does not 
amalgamate the instruments. 

CREOLIN, LYSOL, BACILLOL, AND OTHER CRESOL COMBINATIONS.— 
The antiseptic action of the cresols is pronounced and rapid. A 3% 
solution destroys wound infection organisms. The dis- 
infectant properties of cresol are apparently stronger than those of 
carbolic acid. It further possesses deodorizing properties; itis 
relatively non-poisonous, and inexpensive, its disadvantages are: 
odor, irritating action of strong solutions on the mucous membranes, 
gradual destructive action on rubber tubes, cloudiness of the solutions. 

CARBOLIC ACID.—The action is relatively strong. Most bacteria 
die after a long time in a 3% solution. The official carbolic 
acid solution is mixed in a 4% solution. The action of carbolic acid 
seems to be slight towards the infectious material of tetanus, rabies, the 
tubercle bacillus, and the spores of anthrax. Castration clamps, for 
example, transmitted tetanus after eighteen months, notwithstanding 
the fact that they were placed in a 4% solution of carbolic acid for five 
minutes (Nocard). Advantages: its strength is constant and it does 
not decompose. Disadvantages: cost, odor, irritating and toxic action, 
especially the latter, for cats. 

IODOFORM.—This is an excellent, mild stimulator of granulations ; 
also used in etherial solutions 1:5-10). Disadvantages: odor, 
cost, toxicity for dogs (licking), insolubility in water. The following 
similar preparations from iodine are expensive ; for this reason they are 
not much employed in veterinary surgery: lorentin, losophan, iodo- 
phen, europhen, aristol, iodoformin, iodoformogen, iodol, iodtrichlorid 
(easily decomposed). In actinomycotic infections, iodine and iodide of 
potash in aqueous solution (Lugol’s solution) is a specific for 
actinomycotic infection. 

TANNOFORM.—At the present time this isour best aseptic cov- 
ering and dry antiseptic. Applied early to cuts, it checks 
suppuration (healing under an eschar). In horses it is preferable to 
iodoform on account of being 2 more active and non-odorous antiseptic. 
Other formaldehyde preparations are: glutol, amyloform, and 
others ; they are more expensive and their action is less constant than 
that of tannoform. Formaldehyde, itself, in a 1 to 2% solution is a 
strong disinfectant, it irritates the wounds however ; it is very caustic 
when concentrated (caution!). 

NITRATE OF SILVER.—This is an excéllent wound dress- 
ing. Itisastrong disinfectant (a 1: 100 solution is fatal to pus cocci). 
It is a valuable regulator of abnormal granulations, and leaves a pro- 
tective covering in the form of an eschar (eschar of silver). The same 
is true of the more recent but very expensive preparations of silver 
(argentum lacticum and citricum, actol, itrol, protargol, 
ichthargan). 


60 ANTISEPTICS 


SOLUTION OF ALUMINUM ACETATE.—This is an excellent non- 
toxic antiseptic ina 2-8% aqueous solution (also contained in Bur- 
row’s solution); because of the expense it is preferable to the more 
costly substitutes: alumnol, tannal, gallal, sozal, boral, salumin, 
cutol, etc. 

BISMUTH SALTS.—These are absorbing, astringent, dry 
antiseptics; their action is similar to tannoform, they seem to be 
more expensive, however. The following are most often employed : 
bismuth subnitricum, subsalicylicum, gallicum (dermatol), 
dithiosalicylicum (thioform), airol (iodid of dermatol). The latter in the 
form of AIROL PASTE is an excellent aseptic protective covering foi 
wounds; it is non-irritating, easily applied, dries rapidly, and is very 
adherent. 

ALCOHOL.—This is an important agent for disinfecting 
the hands of the operator and the skin of the operating 
field. Itis best employed in the form of a 50% aqueous solution or 
aqueous solution of sublimate (absolute alcohol has only a weak anti- 
septic action). Alcoholic soaps are also employed. Alcoholic 
TINCTURE OF ALOKS stimulates granulations on old wounds and is an 
active antiseptic. TINCTURE OF IODINE is an excellent disinfectant 
for infected wounds that have a tendency to necrosis. 

SALICYLIC AcID.—A weak antiseptic,it is non-poison- 
ous however, odorless and non-irritating. It finds ap- 
plication in ophthalmology, in irrigation of the internal organs of the 
body, and in the treatment of cats. Thioform (bismuth dithiosali- 
cylate) isa substitute for iodoform. It is especially employed because 
of its non-odor and non-toxicity (very expensive !). 

Boric Acip.—A mild, non-toxic, and odorless antti- 
septic; its action is slight (ophthalmology, irrigation of the 
uterus). The following, with other solutions of boric acid, possess a 
similar action: borax and borate of magnesia, boral, an- 
tipyonin, rotterin, antiseptin, borol. 

CHLORIDE OF ZINC.—A caustic antiseptic (2-8% solu- 
tion), its action as an antiseptic is relativelyuweus 
(common agent for abnormal granulations). 

CALCIUM PERMANGANATE.—Weak antiseptic. Specific against 
snake bites and the toxin of rabies. 

CampHor.—A powerful antiseptic, especially for torpid gran- 
ulations, phlegmons, and necrotic processes (spirits of 
camphor bandage). Those agents which have a similar action are: 
oil of turpentine, turpentine (old hoof remedies), thymol 
oil of eucalyptus, balsam of Peru, and other etherial oils. 

Tar.—An excellent antiseptic, especially for wounds of the hoofs 
and claws. Wood tar is preferable to coal tar. 

AQUA CHLORATA.—Strong antiseptic. Specific for rabies 
and snake bites. Eniployed in ophthalmology. 


OPEN WOUND TREATMENT AND BANDAGING 61 


PYOCTANIN.—Active antiseptic. Disadvantages: blue color. 

HEAT.—By means of high temperature pus bacteria die in 
ten minutes at a temperature of 55-62°, the streptococcus of strangles 
at 60°, the tetanus bacillus at 75°, the spores of tetanus at 100°. 


OPEN WOUND TREATMENT AND BANDAGING.-—If a wound 
is aseptically or antiseptically handled, and eventually sutured, 
a bandage should be applied wherever possible. It protects 
the wound from the entrance of infection (air, and contact 
infection), as well as irritants. The bandage should be dry. 
Such a bandage is termed a dry, aseptic wound band- 
age. A moist antiseptic bandage is better for ex- 
tensive wounds, pronounced suppuration, phlegmons, prepa- 
ration of certain portions of the body for operating, etc. The 
moist bandage combines protection with a continued antiseptic 
action ; it neutralizes the action of the wound secretions; the 
moist warmth assists granulation and cicatricial formation. 
Through maceration of the skin and horn it may occasionally 
become injurious. When a bandage is not changed for a long 
time itis termed a permanent bandage. Other forms 
Depoancages ate. estinpie, J.ister, pressure, dry 
dressings, ointment and tar bandages, -iodo- 
form batidages, antiseptic tamponade,. ete. 
With referance to bandage materials and bandage technique 
see: Bayer, Operationslehre. Only the most important rules 
Tepe amdacine are given here. These are: 1. Every 
wound, when possible, should be bandaged. 2. The bandage 
should, after aseptic operations, remain in position as long as 
possible (following resection of the lateral cartilage, for ex- 
ample, fourteen days). 3. The bandage must be changed, 
however ; (a) when it becomes saturated with pus, wound se- 
cretions, or filth; (b) when improperly applied; (c) when 
there is pain or pronounced swelling in the vicinity of the 
wound, or when fever exists. 

In veterinary practice the open treatment of 
wounds must often replace bandaging. This is especially 
true of horses and cattle, in which the application of a bandage 
in various parts of the body is impossible (gluteal region, up- 
per limbs). In such wounds the oxygen of the air acts as a 


2 


62 TREATMENT OF DIFFERENT KINDS OF WOUNDS 


disinfectant ; it is of special value in malignant edema. For 
this’ reason, the suturing of old oT eee 
wounds is contra-indicated. The aseptic wound 
bandage is most readily applied to dogs. When a bandage 
cannot be applied healing under eschar may occur 
(dry or moist blood-eschar ; necrosed eschar; one formed by 
tannoform, tannin, silver nitrate, dry dressings, etc.). Oint- 
ments may take the place of a bandage (boric acid, silver 
nitrate, decubital salve, etc.). Adhesive remedies per- 
form the same function (airol paste, iodoform-colodion, zinc 
paste, bismuth paste, adhesive plaster). In many cases, as in 
human surgery, permanent irrigation is employed 
with good results, that is, the wound is irrigated for a long 
time with an antiseptic fluid. Immersion (water bath) has a- 
very limited field of application (hoof baths, baths for mange). 
Antiseptic cataplasms are employéd to encourage the 
sloughing of necrotic tissues in hoof injuries, fistulous withers, 
etc., (linseed meal bandage with creolin water). The appli- 
cation of linseed meal to any wound is not considered good ~ 
surgery at the present time (Translator). 

TREATMENT OF THE DIFFERENT KINDS OF WOUNDS.—I. Fresh 
incised, punctured and lacerated wounds or bites are 
treated as follows: arrest the hemorrhage; irrigate; disinfect; and 
drain ; apply an aseptic tampon; suture as muchas possible; and when 
practical, apply a bandage. 

2. Contused and old, especially suppurating wounds, are not 
sutured; otherwise they are treated as fresh incised wounds. In 
many cases of smail, old, suppurating wounds, heal- 
ing by third intention is possible; the modus ope- 
randi is as follows: trim the margins, irrigate care- 
fully for a long time, disinfect, remove all negrome 
portions, bring the margins of the wound in close 
apposition by means of sutures (wounds of the head in the 
horse). When removing foreign bodies or destroyed tissues from con- 
tused wounds care should be taken not to remove the sound tissue also. 
This is particularly true of flap wounds (treads on the coronet), where 
the retention of small flaps‘of skin is of greatest 
importance. Contused wounds with pronounced suppuration and 
tissue necrosis are best treated by means of moist bandages; as 
open wounds; or with permanent irrigation. 

3. Shot wounds are treated according to the same rules of asepsis 
and antisepsis as those employed for the treatment of ordinary wounds. 


TRANSPLANTATION 63 


As experience in men has proved that bullets are frequently encapsuled, 
expective treatment should usualy be followed, do 
not favour extraction of the bullet (v. Bergman, Kocher), 
Probing of the wound is also superfluous ; when the finger or probe are 
not carefully disinfected it is even dangerous to life (keep the finger 
and probe away). Shot wounds are best treated as follows: anti- 
septic occlusion and tamponade; or drainage with- 
out suture followed by a bandage. If for certain reasons it 
seems necessary to extract the bullet (phlegmons, pain, high fever, 
etc.), a simple incision is often all that is necessary ; employ foreign- 
body forceps, curette, etc., in place of special bullet forceps. 

4. Joint wounds, when fresh, should be carefully disin- 
fected; sutured; and when possible, covered withan aseptic 
occlusive bandage. It is not always possible to bandage perfo- 
rating joint wounds in horses and cattle; in those cases one may use 
iodoform-collodion, airol paste, and other adhesive materials, the cau- 
tery may be used to close the wound witha necrotic eschar, per- 
manent irrigation is alsoemployed. The earlier employed caustic ap- 
plications in the vicinity of the joint (closure of the wound by swell- 
ing) are of little value. Suppurating joint wounds in dogs may be 
drained, irrigated, incised if necessary, and packed with an antiseptic 
tampon. In horses and cattle they are frequeutly incurable. 

5. Perforating abdominal wounds require careful 
antisepsis; reposition of the intestines after thorough disinfection ; 
ligation and removal of the prolapsed omentum, as well as a double 
suture. 

6. Poisoned wounds (snake poison, rabies, etc.) may be ex- 
cised ; cauterized ; burned ; or treated with specific disinfectants ; po- 
tassium permanganate, aqua chlorata, liquor ferri 
chloridi, and calcium bichromate in the form of sub- 
cutaneous injections. 

“7. Wounds that are granulating abnormally are 
treated with the knife, curette, cautery, caustics (nitrate of silver and 
chloride of zinc), ointment bandages, tincture of aloes, etc. See treat- 
ment of ulcers. 

TRANSPLANTATION.—This was first employed by Reverdin, in 
the year 1870. It was employed in human surgery to provide a rapid 
covering for granulating wound surfaces. Thiersch also had a 
broad experience in the transplantation of epidermis. Formerly, pieces 
of skin, the entire thickness of the epidermis, were transplanted. At 
the present time the modus operandi is as follows: the rules of asepsis 
are very carefully observed ; very thin, superficial sections of the skin 
are removed with a razor, they extend, however, to the papillary bodies ; 
these sections are about the length and breadth of one’s finger, they are 
removed from the upper arm or limb, and are transferred from here to 
the granulations. The granulations have been previously freshened 


64 SUBCUTANEOUS INJURIES OF THE SOFT PARTS 


with a curette, the flaps of skin are applied without coming in contact 
with any antiseptics (necrosis of the epidermis), they are carefully re- 
tained in position by means of sterilized tin foil, a dry or moist band- 
age (salt solution) is employed for protection. If the transplantation is 
successful the pieces of skin heal to the granulations by first intention ; 
about the third day they are vascularized by vessels from the granula- 
tion tissue; and the wound is covered through the formation of new 
epidermis from these artificial islands of skin. A simpler method con- 
sists in the removal of the epidermis only, from the healthy skin, this 
being placed on the granulations. It is also possible to transplant mucous 
membrane on mucous membrane, as well as pieces of bone with perios- 
teum and marrow from living young animals to man. On the other 
hand, the transplantation of nerves, muscles, and tendons, from animals 
to man has not yet been successful. 

The difficulties of transplantion consist in the prevention of death 
of the removed piece of skin on the one hand, and the difficulty of 
fixing it to the granulation tissue on the other. The latter is especially 
dificnlt in animals. Mamadyschski has been successful in horses 
and dogs with Krause’s method of transplantation. Querruau 
has successfully treated saddle pressure in the horse by means of trans- 
plantation. Bayer, onthe other hand, has repeatedly employed trans- 
plantation in horses without results; the great mobility of the skin of 
the horse hinders exact fixation of the flaps, while the firmness and 
non-vascularity of the same does not favour rapid growth. Bayer has 
even retained the flaps by means of sutures and needles without re- 
sults. Also, the hair on the skin of animals often retards growth. On 
the other hand, the transplantation of skin and mucous membrane from 
animals to man is successful; the same is true of the transplantation of 
spurs to the comb of a cock. 


SUBCUTANEOUS INJURIES OF THE SOFT PARTS 
(CONTUSION, LACERATION). 


ty SON TUSION: 
a 
DEFINITION AND CAusES.—In contrast to wounds of 


/the skin and mucous membrane, which are always accompa- 
/ nied by a breach in their continuity, a contusion is an 


injury to the soft parts without an external 
wound. It is caused by pressure from a blunt instrument, 
the skin, because of its elasticity, remaining uninjured, while 
the underlying soft parts, especially those covering bone are 
torn. Contused wounds and contusions are due to the same 


GRADE OF CONTUSION *65 


causes. In every other way they are different, namely, symp- 

toms, course, treatment, and prognosis. This is due to the 

fact that contused wounds are open to infection, while in sub- 

cutaneous injuries of the soft tissues the paths of infection are 

closed. — 

~~ ‘Phe causes of contusions in the domestic animals are 
various. In horses they are caused by pressure from the 
harness, saddle, bit, shoe, faulty nailing of shoes (corns, 
nailing), calks, kicks, blows, and falls, entering doors, self- 
inflicted injuries from treads on the coronet, decubitis, etc. 
In cattle they are caused by horn-thrusts. Bites and chastise- 
ments frequently produce contusions in dogs. 

GRADE OF Contusion.—According to the severity and 
extent of subcutaneous injuries, different grades of contusions 
are recognized ; differentiation being based on the injuries to 
blood-vessels. The simplest division is that which separates 
a contusion with preservation of tissue from one that 
results in necrosis. According to the extent of hemorr- 
hage the first may be further subdivided into contusions with 
slight or severe hemorrhage. In general, therefore, 
three grades of contusion are recognized : 

1. Contusions of the first grade are character- 
ized by a slight amount of hemorrhage. The extravasate may 
be evenly distributed through the contused tissues (bloody | 
infiltration), orit may occupy small circumscribed foci 
(ecchymosis, petechia),. . 

2, ‘Contusions of ‘the .second: grade lead 
either to large subcutaneous accumulations of blood (hema- 
tomata ), there are also alleged to be circumscribed effu- 
sions of large quantities of lymph (lymph-extrava- 
sate), orto a superficial accumulation of a large amount of 
blood (suffusion). 

3. Contusions of the third grade result in 
gangrenous death ot the involved tissues (necrosis, mortifica- 
tion). The cause of death is due to the deranged circulation 

« brought about by extensive injuries to the blood-vessels (pri- 
mary anemic necrosis). Necrosis may also be due to en- 
trance of infection from without or through the blood-stream 


“a 


66 SYMPTOMS 


(secondary septic necrosis). Hxperimental investigations 
have proved that the contusion of itself does not cause necrosis. 

Compiete crushing of the contused parts is sometimes 
termed a contusion of the fourth grade. 


MiIcROscoPIc CHANGES IN COoNTUSIONS.—The following conte 
tions are found in contusions that are experimentally produced in ani- 
mals: In contusions of the first grade only a laceration of the loose 
connective tissue, that which is supplied by the smallest blood-vessels. 
In contusions of a severe grade there is also laceration of the intercellu- 
lar substance of the tissues, so that the cells are separated from one an- 
other. In the severest crushing of the tissues, however, 
the cells usually remain unimpaired. This explains the 
fact that crushing, alone, does not result in necrosis (Gussenbauer). 


SympToms.—Swelling, due to hemorrhage, is the most 
important symptom (contusion swelling). In contusions of 
the first grade (bloody infiltration) the swelling is small and 
diffuse. Large circumscribed swellings characterize second 
grade contusions (hematomata). Hematomata on the hind 
' limbs of horses become especially large (larger than one’s 
head); I observed one case in the region of the udder in a 
horse in which the hematoma contained 25 liters. Contusions 
may occur in the following places: skin, mucous membrane, 
subcutem, subfascia, intermuscular tissues, in the vicinity of 
joints, within joints (hemarthrosis), in the tunica vaginalis 
(hematocele, etc.). Superficial excoriations sometimes occur 
on the skin over the contused area. As long as the contused 
swelling contains nothing but extravasate, without any mate- 
rial injury to the skin, and no infection from without, inflam- 
matory symptoms are absent. Thisis true of hematomata and 
is an accurate means of differentiating between a hematoma 
and an abscess. The consistence of the swelling is usually 
softer, fluctuation is pronounced, on palpation crepitation may 
be noted (coagulum of blood). When the contused tissues 
are rich in nerves, pain may accompany the swelling. ‘This 
causes lameness when the seat of injury is in the following 
regions or tissues: hoof, periosteum, muscles, and nerves. 
Severe contusions of the nerves, spinal cord, and brain lead to 
paralysis, insensibility, and unconsciousness. A reflex paraly- 
sis of the central nervous system may result from severe peri- 


COURSE 67 


pheral contusions (so-called shock). General symptoms are 
usually absent. Symptoms of anzemia are observed only in 
rupture of large blood-vessels. Resorption of extravasate from 
severe contusions may be followed by febrille symptoms (asep- 
tic resorption fever), and swelling of the lymph-glands. Fat 
emboli of the lungs have occurred in man. Inflammation asa 
result of contusion may result in suppuration and necrosis, it 
may also assume the form of septicemia. 

CoursE.—The termination of the blood-extravasate de- 
pends upon its size, the degree of contusion, and the infection 
or non-infection of the wound, it is, therefore, variable. The 
blood may become resorbed, or encapsuled, orga- 
nization, suppuration, or necrosis may also occur. 

1. Resorption, that is, the absorption of the extra- 
vasate through the lymph-vessels, usually follows subcutane- 
ous contusions of the first grade; small hematomata are occa- 
sionally absorbed in the same manner. The component parts 
are resorbed in the following order: the blood-serum, the dis- 
solved fibrin, the degenerated white blood-corpuscles, and 
finally the red blood-corpuscles ; the latter are resorbed partly 
in toto, partly in a degenerated condition. The resorbed red 
blood-corpuscles sometimes accumulate in the lymph-glands 
to such an extent that the latter have an appearance of dark- 
red swellings. Red blood-corpuscles which remain in the con- 
tused areas undergo granular degeneration and give off their 
coloring matter. The latter is diffused in the surrounding 
tissues and is transformed into a crystalline hematoiden 
or a soluble choleglobin out of whichare developed color- 
ing matters similar to those found in the gall; green, red, blue, 
and black (melanin) (Latschenberger). These are visible 
only in unpigmented skin where they appear in the form of so- 
called black and blue spots. Later they are resorbed and dis- 
appear. 

2. Organization and encapsulation, so-called, 
occur in relatively large hematomata. In the vicinity of the 
hemorrhagic focus there exists, as a result of proliferation of 
the autochthonous tissue cells, a cellular infiltration with the 
formation of fibrous connective tissue. This gradually dis- 


68 DIFFERENTIAL DIAGNOSIS 


places the extravasate and, similar to the so-called organiza- 
tion of a thrombus, forms a connective-tissue indu- 
ration as the product of an aseptic, interstitial inflamma- 
tion (tumor fibrosus). When the connective-tissue 
mass does not displace the extravasate, but the inflammatory 
process runs a chronic aseptic course around its periphery, as 
around foreign bodies, the extravasate finally becomes encap- 
suled by a connective-tissue membrane (blood-cyst, 
hygroma). ‘This process of cystic formation is frequently 
observed in dogs. I have observed one case in which the 
capsule developed in fourteen days. In the horse one occa- 
sionally finds small, moveable blood-cysts located subcutane- 
ously in the region of the withers, as well as subcutaneous 
hygromata with free bodies (corpora libera). Caseous in- 
crustations, even cartilaginous and osseous 
degenerations, may result from the organization of a 
hematoma (othematoma in dogs, subperiosteal hematomata). 
3. Suppuration and ichorous ulceration in 
contused swellings is only the result of the entrance of infec- 
tious material into the blood-extravasate. A hematoma then, 
may terminate in an abscess, under certain conditions the 
abscess may become encapsuled (shoulder abscess). Diffuse 
bloody infiltrations terminate in phlegmons, necrosis 
may develop during the course of the latter and, in case of 
complications, pass into septicemia or pyemia. 
DIFFERENTIAL DIAGNosIs.—Contusions run an ex- 
tremely variable course, they may become complicated with 
wound infection diseases, and they are often confused with 
other surgical affections. One must consider tumors, 
phliegmons, hernia, and fractures (crepitation). 
It is of great practical importance to differentiate between 
hematomata and abscesses. One must remember that hema- 
tomata develop suddenly over their entire area ; abscesses de- 
velop slowly. A genuine hematoma is not characterized by ~ 
inflammatory symptoms nor general febrile conditions. ‘The 
periphery of an abscess is hard, that of a hematoma is fluctu- 
ating. In doubtful cases one may use the exploratory probe. 


TREATMENT 69 


TREATMENT.—The treatment of contused swellings is 
variable ; it depends on the degree of the contusion. 

i. Slight, circumscribed blood- extrava- 
sates may be treated with massage, moist heat, and com- 
pression, as well as counter-irritants. The object being to 
bring about resorption. 

2. Large hematomata are best treated by means 
of an incision, this should not be made tooearly. Extirpate 
encapsuled blood-cysts ; ‘aspiration, with a subsequent injec- 
tion of tincture of iodine is sometimes effectual. Encapsuled 
hematomata and hygromata may occasionally be ruptured 
with force. 

3. Necrosis, phlegmon and abscess forma- 
tion should not be treated with massage. Suppurative and 
necrotic inflammations are treated according to the rules of 
antisepsis ; incise, remove the necrotic tissue, drain, and dis- 
infect. 

_ THE most IMPORTANT CONTUSIONS OF DomEstTiIc ANI- 
MALS.—The following affections are of special practical im- 
portance : 

1. Contusion of the neck, withers, on the sad- 
dle position, point of the shoulder, on the ster- 
num, and in the vicinity of the shoulder in the horse (poll- 
evil, fistulous withers, saddle galls, sternal 
and shoulder abscess). 

2. Contusions of the upper and under lips 
(twitch), the skin at the angle of the mouth (bit), and 
the mucous membrane of the interdental space of the infe- 
rior maxilla in the horse. 

3. Contusions of the external angle of the ilium, orbital, 
process, zygomatic region, etc., especially in horses and cattle 
(decubitis). 

4. Hematomata in the gluteal region, especially in 
the region of the buttocks, onthe anterior surface of the 
carpal joint, and on the inner surface of the metacar- 
pus in the horse. 

5. Bursitis intertubercularis and trochan- 
terica in horses. 


70 LACERATION (RUPTURE) 


6. Contused swellings on the elbow in the horse and dog 
(shoe-boil). In dogs they may occur on the neck, or at 
the tuberosity of the ischium. ; 

7. Contused swellings on the anterior surface of the car- 
pal joint in horses and cattle, especially in working oxen 
(knee tumor). 

8. Contused swellings over the tuberosity of the os calcis 
in horses (capped hock) ; the same on the posterior sur- 
face of the os calcis (curb). 

9. Treads on the coronet, contusions of the 
pododerm at the angle of the sole (corns), as well as 
contusions of the balls of the hoof (sore heels). 

10. Hematomata in the vicinity of the udder, anterior 
and posterior in cattle (milk-vein, posterior abdominal vein). 

Ir. Hematomata and blood-cysts on the throat and back 
of dogs. 

12. Hematomata on the inner surface of the ear muscles. 
in dogs (othematoma, hematoma auris). 

LYMPH EXTRAVASATE.—This name applies to contused swellings 
which are not filled with blood, but with lymph; they are due to lacera- 
tion of large lymph-vessels (lymphorrhea). According to Gussenbauer 
they occur when, as the result of a contusion, the skin is raised from the 
underlying parts (fascia) and slides over the firm subcutaneous struc- 
tures. Incontrast to hematomata, lymph-extravasates result in swellings 
which develop slowly, so that growth is observed for weeks and even 
months. The effusion of lymph does not coagulate as long as the skin 
remains intact. On account of chronic development and inability of 
thrombus formation, as well as resorption, the prognosis is unfavorable. 
Hoffman has described two cases in the horse (buttocks); he also men- 
tions having observed one case in the cow and dog (ear). Hoffman 
further refers the so-called knee tumors in horses and cattle to extrava- 
sations of lymph. Moller and Bayer contradict the occurrence of pure 
lymph-extravasates on the posterior limbs of horses and on the ear 
muscles of dogs; they point out the possibility of a confusion with hem- 
atomata. I, myself, have not yet observed a lymyh-extravasate in 
either the dog or horse. 


II. LACERATION (RUPTURE). 


MuscLE RupPpTuRE.—This term indicates a subcutaneous 
break in the continuity of individual muscles as a result of 


TENDON RUPTURE 71 


severe stretching and tension of the muscles, it is due to blunt 
forces from without, or pronounced muscular contraction 
(spontaneous rupture): distinguish between this and open 
muscular wounds. The rupture may be complete or incom- 
plete. Diseased muscles are predisposed to rupture (idio- 
pathic muscle-rupture). The symptoms are deranged mobil- 
ity, the presence of a space or blood-extravasate at the point 
of rupture, and a hernia (abdominal muscles). Healing fol- 
lows through resorption of the blood-extravasate and the 
formation of a connective-tissue cicatrix; there frequently 
remains a shortening of the muscles (muscle-contracture). 
Ruptures of abdominal muscles in large animals are usually 
incurable (ventral hernia). ‘Treatment consists in the applica- 
tion of a pressure bandage whenever possible. Indogsa skin 
incision may be made and the muscles sutured. Muscle-rup- 
tures are usually seen in horses and cattle. They most fre- 
quently occur in the following places: the tibialis anti- 
cus, the rectus, obliquus and transversus ab- 
dominis; the quadriceps femoris (especially 
Prem vaste, ~ateralis); the |‘gastrochnemius; 
Sune al; tie. preeps brachit and femoris; the 
ameaqnens; the levator humeri; ‘pectoralis 
minor; longissimus dorsi; psoas; gracillis; 
infraspinatus; and tensor fascia lata. 

TENDON RupTruRE.—Tendon-ruptures also, should be dis- 
tinguished from tendon-wounds, they are subcutaneous breaks 
in the continuity. The causes are identical with those which 
produce muscle-rupture. Asarule they areof external origin 
(overextension). They may, however, be due to an inner 
predisposition, such as diseased tendon following inflamma- 
tion, deranged nutrition, or necrosis (idiopathic ruptures 
of tendons during the course of suppurative inflammations of 
tendon-sheaths, or contagious pleuropneumonia). Complete 
and incomplete (partial, fibrillar) ruptures are recognized : 
with reference to the latter, see chapter on inflammation, this 
being the most frequent cause. Complete tendon-ruptures in 
the horse most frequently occur in the flexor pedis per- 
forans, flexor pedis perforatus, flexors of the 


72 INFLAMMATION 


metatarsi, and suspensory ligament; the ex- 
tensor pedis and achilles tendon are seldom rup- 
tured. In cattleanddogs the flexor metatarsi and 
achilles tendon aremost oftenruptured. Thesymptoms. 
of tendon-rupture consist in a peculiar lameness, as well as the 
occurrence of a space between the ends of the ruptured tendon 
(this is not present in rupture of the tibialis, and flexor pedis 
tendon in the hoof). On anatomical examination one finds a 


“. blood-extravasate in the vicinity of the rupture, the ends of 


the ruptured tendon are fibrous, and covered with blood. 
Healing follows resorption of the blood, through the formation 
of a connective-tissue cicatrix from the tendon-sheaths, the 
paratendineum, and the interfasicular connective tissue; this 
afterwards takes on the character of tendon-tissue and may 
finally lead to tendon-contracture. ‘Treatment consists in the 
application of a plaster-of-Paris bandage; in dogs a tendon- 
suture may be applied (compare with the chapter on diseases 
of the tendons). 

RUPTURE OF -FASCIA.—-Subcutaneous rupture of fascia 
may lead to the formation of a so-called muscle hernia, 
that is, to the protrusion of a portion of the muscle through 
the rent in the fascia. I have observed many cases in horses 
on the posterior limbs, on the neck, and on the shoulder (her- 
nia of the semimembranosus and levator humeri). With ref- 
erence to rupture of vessels, nerves, and articular 
ligaments refer to the chapter on diseases of the vessels, 
nerves, and joints. 


INFLAMMATION. 
I. NATURE AND CAUSES. 


NATURE.—Inflammation is a highly complicated reac- 
tive process in'irritated tissues. According to 
the investigations of Cohnheim, v. Recklinghausen, 
Pfeffer, Metchnikoff, and others, the principal changes 
are as follows : 

1. The irritation of péripheral centermeuen 
‘circulation produces, reflexly, a vasodilitation 


THEORIES OF INFLAMMATION 73 


(vasodilators) of the arteries, veins and capillaries of the in- 
volved tissues ; this is the first change that occurs. 

2. Acceleration of the blood-stream occurs with the vaso- 
dilitation. This is soon followed by a diminished ve- 
locity in the flow of the blood; finally the flow of 
the blood is entirely suspended (stasis). 

3. When retardation of the blood-stream occurs, the 
white blood-corpuscles are arranged next to 
the vessel walls, especially in the veins; while the 
red blood-corpuscles occupy the center of the stream. At this 
period the white blood-corpuscles pass through the walls of 
the vessels (Migration) in the direction of the irritant (che- 
motropismus, chemotaxis, phagocytosis), 
whereby cellular infiltration of the inflamed tissue 
occurs. . 

4. Asa result of changes in the vessel walls 
there occurs an active transudation of blood- 
serum through the diseased walls of the vessels. (inflam- 
matory transudate, exudate), occasionally there is 
also a passage of red blood-corpuscles through 
the capillary walls (diapedesis). In this way the so- 
called inflammatory swelling is produced. 

5. Finally, in addition to the emigrated white blood-cor- 
puscles, the fixed autochthonous connective- 
tissue cells proliferate (division, proliferation) and 
take part in the inflammatory process, especially in the cellular 
infiltration. 

THEORIES OF INFLAMMATION.—According to recent theories on 
inflammation the primary process is the irritation of the 
local vasomotor nerves; the secondary process is the migration 
of the white blood-corpuscles according to the law of chemotaxis, as 
wellas the changes which take place in the vassel walls (v. Reck- 
linghausen). The importance of chemotaxis for the process of 
emigration of the white blood-corpuscles has been clearly demonstrated 
by Pfeffer. Formerly the primary, essential processes were supposed 
to be the changes in the walls of the vessels, the inflammatory exuda- 
tion, and the migration of the white blood-corpuscles (emigration 
theory of Cohnheim). Metchnikoff demonstrated the phago- 


cytic theory whereby the white blood-corpuscles form a protection 
against the entrance of inflammatory irritants by migrating and de- 


74 CAUSES OF INFLAMMATION 


stroying them (devouring cells). According to Metchnikoff inflamma- 
tion is merely a “phagocytic reaction” with certain attendant 
symptoms. Among the old theories of inflammation, the humoral, 
cellular and neural theories are of historical interest. Virchow es- 
tablished the cellular theory of inflammation, according to which, the 
inflammatory stimuli irritate the cells of the tissues, these hypertrophy 
and proliferate thus drawing large quantities of fluid nourishment from 
the blood (attraction theory, nutritive stimuli). The 
humeral theory of inflammation accounts for the nature of inflammation 
in changed conditions of the blood (dyscrasia). According to the neural 
theory the nervous system plays the principal part in inflammation 
(paralytic and spasmodic theories of inflammation by Brucke, 
Stilling and others). 

CAUSES OF INFLAMMATION.—The inflammatory stimuli 
that are operative on animal tissues are extremely variable in 
their nature. Mechanical, chemical, thermic and 
infectious causes may prepare the tissues for inflammation. 
In general inflammation according to causes may be divided 
into two, practical, very important groups. One group may 
be termed an aseptic or non-bacterial (non-infec- 
tious) inflammation; it is caused, not through the action of 
bacteria, but as a result of mechanical, thermic, and chemical 
influences (traumatic inflammation, burning, acrids). The 
' other group includes the septic or bacterial (infec- 
tious) inflammations; they are due to the activity of micro- 
Organisms. The following are the most important causes of 
inflammation : . 

1. Mechanical irritants (wounds, pressure, con- 
tusions, strains, ruptures) produce the so-called traumatic 
inflammations: wound healing by first intention, healing of 
subcutaneous bone-fractures, muscle and tendon-ruptures, that 
form of inflammation of the pododerm known as laminitis, 
non-infectious inflammations of the joints (spavin, ringbone, 
chronic deforming gonitis, omarthritis and coxitis, chronic 
podotrochlitis), tendons, tendon-sheaths, mucous bursz, and 
bones. A purely traumatic aseptic inflammation may combine 
with one that is bacterial and infectious in character (healing 
per secundam, healing of compound bone-fractures). 

2. Thermic irritants in the form of heat and cold. 
Purely aseptic inflammations of this kind are burns (red- 


CAUSES OF INFLAMMATION | 75 


ness, vesicles) and rheumatic inflammations, especially mus- 
cular rheumatism (non-bacterial inflammation of mus- 
cle due, simply, to irritation from cold). These thermic 
aseptic inflammations may afterwards combine with one that 
is infectious in character (suppurative infection of blisters). 

3. Chemical irritants may produce various kinds and 
grades of inflammation without the aid of bacteria, especially 
suppurative inflammations. Experimental subcutaneous in- 
jections of sterilized chemicals (oil of turpentine, creolin, 
nitrate of silver, ammonia, and legumin) under aseptic precau- 
tions, produce an acute suppurative inflammation in the ab- 
sence of bacteria (Grawitz, De Bary and others). Inflamma- 
tion due to chemical irritants is of practical importance in ther- 
apeutics: through the application of irritants to the skin 
various grades of inflammation are produced for the object of. 
healing (rubefacients, vesicants, pustulants, suppurants). 

4. Infectious inflammations are caused by the en- 
trance of microorganisms into the tissues. There are a great 
many kinds of bacteria that may cause bacterial or septic in- 
flammations; namely, staphylococci, streptococci, edema 
bacillus, tubercle bacillus, glanders bacillus, anthrax bacillus, 
botryomyces and actinomyces. Examples of infectious in- 
flammations are: suppuration of wounds, phlegmons, suppu- 
rative arthritis, tendovaginitis and pododermatitis. None 
of these organisms are mechanical irritants; 
Piruagaiearion ws ‘due to their chemical pro- 
(iets Oorenetabolism (toxins). leber was the 
first to discover that infectious inflammation was due to chem- 
ical irritants. From a culture of staphylococcus he isolated a 
crystalline chemical substance (phlogosin) that has the pro- 
perty of inducing inflammation. ‘The so-called parasitic 
inflammations (sarcosporidia ) are of slight significance from a 
surgical standpoint ; they also appear to be due to the action 
of chemical bodies (sarcozystin ). 

Finally, certain factors of the disposition have an 
influence in the production of inflammation (constitution, idio- 
syncrasy, immunity). 


76 KINDS OF INFLAMMATION 
II. KINDS, SYMPTOMS, AND COURSE OF INFLAMMATION. 


KiInps OF INFLAMMATION.—According to the character 
of the exudate various kinds of inflammation are recognized : 

1. Serous inflammation is characterized by a 
serous, watery, lymph-like exudate containing very few white 
and red blood-corpuscles. Itis the slightest grade of inflam- 
mation ; the blood-vessels are only slightly changed. It occurs 
intheskin and subcutum (inflammatory edema, blisters, 
dermatitis bullosa); on the serous membranes of 
the joints, tendon-sheaths, and mucous bursae 
(serous arthritis, tendovaginitis and bursitis; hydrops of the 
joints, tendon-sheaths, and mucous bursz) ; as well ason the 
mucous membranes (catarrhal inflammation). 

2. Fibrinous or croupous inflammation is char- 
acterized by the formation of an exudate that is very rich in 
fibrin and white blood-corpuscles. As a result of this, 
croupous membranes (so-called fibrinous pseudo-membranes) 
are deposited on the inflamed tissues; leucocytes and fibrin 
threads make up the essential composition of these mem- 
branes.- If a serous exudate is present at the same time it is 
termed a sero-fibrinous inflammation. Fibrinous in- 
flammations most frequently occur on the serosa of the joints, 
tendon-sheaths, and mucous bursz (arthritis, tendovaginitis, 
bursitis fibrinosa), on the mucous membranes (membranous 
conjunctivitis, as well as on the iris (fibrinous iritis of moon- 
blindness). . 

3. Suppurative inflammation is a special form 
which is usually due to an infection with pus-forming bacteria 
(streptococcus and staphylococcus pyogenes). ‘The suppura- 
tive exudate is composed partly of emigrated white blood-cor- 
puscles, partly of proliferated fixed connective-tissue cells. 
A circumscribed collection of pus in a tissue is termed an 
abscess. A diffuse suppurative inflammation is termed-a 
suppurative infiltration; an accumulation of pus in 
joints, or in the cavities of the head, is termed empyema; 
suppurative inflammation of the mucous membranes, suppu- 
rative catarrh; of the mucuous membranes of the eye, 


SYMPTOMS OF INFLAMMATION yy 


blennorrhea ; the skin of the external auditory canal, otorr- 
hea; purulent vesicles on the skin are termed pustules. 

4. Diptheritic inflammation consists of a coagula- 
tion necrosis of the mucous membranes; that is, in a deposit 
of fibrin in the tissues with necrosis of the cells. It leads, 
either to the formation of a so-called diptheritic pseudo- 
membrane, or to a loss of substance (diptheritic 
ulcers). 

5. Hemorrhagic inflammation is characterized by 
the presence of large numbers of red blood-corpuscles in the 
exudate, which have left the vessels either per diapedesis of 
per rhexin. This form of inflammation always involves severe 
alterations in the walls of the blood-vessels. 

6. Necroticor gangrenous (ichorous, putrid) 
inflammation is characterized by a discolored exudate under- 
going putrid degeneration (mixed infections with septic bac- 
teria and putrefactive fungi. ) 

wopProductive or proliferative ‘Chyperplastic) 
inflammation runs a chronic course, and results in new forma- 
tions of tissue (thickenings, adhesions). According to the 
character of the new tissue it is termed indurated, 
Se ricer otcupuscsifying,, deforming, adhesive, 
pannous, fungous, verrucose, ete. 7 

8. Specific inflammations correspond to specific in- 
fectious diseases (tuberculosis, glanders, actinomycosis, botry- 
omycosis, strangles, anthrax). With reference to erysipela- 
tous and phlegmonous inflammations see pages 28 and 46. 

SYMPTOMS OF INFLAMMATION.—The cardinal symptoms 
of inflammation are: heat (calor), redness (rubor), 
swelling (tumor), and pain (dolor) ; disturbed function 
(functio laesa) may be added asa fifth symptom. 

1. Increased heat is most pronounced in acute inflam- 
‘mations. In veterinary science it forms an important sign for 
the determination of the existence of inflammation, as the in- 
flammatory redness is frequently invisible. Heat is due to an 
increased blood-flow, not to an increase in the production of 
local warmth in the inflamed tissue. 

2. Inflammatory redness, in most animals, is usually 


78 TERMINATION OF INFLAMMATION 


invisible in the skin on account of the hair and pigment in that 
tissue, on the mucous membranes, however, it is readily ob- 
served. Redness is due to the dilitation and pronounced fullness 
of the vessels (inflammatory hyperemia). One distinguishes 


between injection redness, where only individual vessels ap- 
pear to be strongly injected, and diffuse inflammatory redness. 

3. Swelling is the result of an increased blood-supply 
and an inflammatory transudate. According to the character 
of the exudate and the kind of tissue in which the disease is 
located, the consistence of the swelling on palpation is ex- 
tremely variable: soft, firm, fluctuating, (abscess, hydrops of 
the joints and tendon-sheaths), or crepitating (fibrinous arth- 
ritis and tendovaginitis). Swelling is most pronounced in the 
widely reticulated tissue of the subcutis, in inflammation of 
the tendon-sheaths, joints, and glands. 

4. Pain is due, partly to the pressure of the inflamma- 
tory swelling on the nerves, partly to the involvement of the 
nerves in the inflammatory process (neuritis). Acute inflam- 
mations of organs that are provided with a rich nerve-supply 
are extremely painful: skin, pododerm, periosteum, joints, 
eyes ; chronic inflammations are usually less painful. Sudden 
relaxation of pain in an acute inflammation indicates a bad 
prognosis (necrosis of the pododerm). 

5. Disturbed function is characterized by lame- 
ness, suspension of the glandular secretions, opacity of the 
cornea, etc. ‘There is also a disturbance of the general condi- 
tion ; this is partly due to the pain, partly to the absorption of 
Bua producing irritants. 

CoURSE AND TERMINATION OF INrL AMA —=One 
recognizes an acute (existing for a few days), and a 
chronic course (longer duration, at least four weeks), occa- 
sionally a peracute (existing a few hours), and a su ba- 
cute (existing for one or two weeks). With reference to 
the extent of inflammations, they are classified as superfi- 
cial, and deep (parenchymatous, interstitial 3 
local or circumscribed, and diffuse or progres- 
sive. Finally we have inflammatory primary and 
secondary foci (metastatic, embolic, general- 


THERAPEUTIC METHODS 79 


ized, that is, an inflammation spread over the entire body 
through the medium of the blood-stream). ‘The following are 
the most important terminations of inflammation: 

1.. The inflammatory product gradually disappears (res- 
olution) asaresult of the resorption of the inflammatory 
product through the lymph-stream under the influence of the 
white blood-corpuscles (phagocytosis, hystolysis). 

2. The retention of inflammatory new forma- 
tions in the form of thickenings, indurations, and adhesions 
(schlerosis, elephantiasis, tendon callus, exostosis, dermatitis 
verrucosa, etc. ). 

3. Gangrene may result from severe disturbances in 
the circulation or complications with septic infection. 

With reference to inflammations of individual organs see 
chapters on inflammations of the bones, joints, muscles, ten- 
dons, nerves, vessels, glands, skin, etc. 


Ill. TREATMENT OF INFLAMMATION. 


THERAPEUTIC METHODS.—Those processes which take 
place in the tissues under the name of inflammation are con- 
sidered necessary reactions of the body whereby external irri- 
tants are expelled, and the body again assumes its normal 
condition through the expulsion of these derangors of its func- 
heise Dbheretoresthe inflammatory process, as 
such, should not be combatted. The essential 
problem of surgical therapeutics consists in the support of the 
body in its endeavors towards self-protection and natural ad- 
justment, rather than in derangement of natural healing by 
means of improper treatment. Direct etiological methods of 
treatment are possible only in cases of septic inflammation 
(antiseptics). In all aseptic inflammations—those not due to 
bacteria—indirect, symptomatic therapeutics are the only 

. ones to be considered. ‘These consist in the application of 
rest, heat and cold, massage and cutaneous 
irritation. 

RxEsT.—Rest for the affected part is the fundamental 
treatment for nearly all painful inflammatory conditions. 


80 HEAT 


Mere rest is all that is required for recovery 
from many inflammations. This is true of distor- 
sions of the joints, aseptic inflammations of the hoof, and all 
chronic deforming inflammations of the joints (spavin, ring- 
bone, gonitis, omarthritis). In any case, rest supports the 
action of other remedies. Motion is seldom indicated : chronic 
inflammation, for example, chronic muscular rheumatism. 
Rest, from a therapeutic standpoint, involves the removal 
of the cause of inflammation—the inflammatory 
irritant—the shoe or nail in inflammation of the pododerm ; 
the saddle, harness, and check-rein in inflammatory conditions 
of the withers, saddle position, and jaw; irritating foreign 
bodies from beneath the lid in conjunctivitis; removal of 
loose pieces of necrosed cartilage and bone in chronic inflam- 
matory processes (fistula of the lateral cartilage, bone-fistula). 

HkrAT.—Heat is indicated in all aseptic forms of in- 
flammation, but especially for the subacute and chronic 
inflammations. Heat favors resorption of the inflammatory 
exudate. This is due to stimulation of the circulation, diffu- 
sion and migration of the phagocytes, as well as to softening 
and breaking down of the inflammed tissue. Heat also re- 
lieves pain by means of relaxation. Moist heat is especially 
useful in the form of frequently renewed Prieznitz ban- 
dages. The bandage is applied cold, this produces at first 
an active contraction of the vessels which is soon followed by 
pronounced dilitation. Frequent application of this bandage— 
every three to six hours—regulates the deranged circulation 
and has a favorable influence on the disturbed general condi- 
tion (temperature, blood-pressure, activity of the heart, dis- 
tribution of the blood, and nervous system). Warm poultices 
(cataplasms) exert a similar action; they are more diff- 
cult to apply to animals (antiseptic cataplasms in inflammation 
of the hoof). Recent methods of heat therapeutics in 
man are the hot-air treatment, the hot-engorge- 
ment (Bier),andthe therapeuticsof light (thermic 
action of red rays, chemical, bactericidal action of blue rays). 
A new heating apparatus with constant action has been in- 
vented by Ullman under the name hydro-thermo- 


COLD roa 


regulator; Bayer has recommended its use for 
foe horse’ The application of heat is con- 
eaeindicated in ivall) septic inflammations, 
especially in septic phlegmons, as well as 
malignant edemas; it favors the extension 
of the process and the multiplication of the 
infectious material. 

_CoLtp.—This is indicated only in septic, as well asin 
the first stages of acute and very painful inflammations (tendon, 
joint, and hoof inflammations). Its action consists principally 
in a contraction of the dilated blood-vessels (anesthetic and 
hemostatic action); it also has an antiseptic action on the 
microorganisms that cause inflammation. Cold retards the 
motility of white blood-corpuscles and even stops their migra- 
tion. The application of cold according to a 
set of fixed rules is more harmful than use- 
fulin aseptic inflammations, because the nat- 
Mmearenealing process of phagocytic reaction 
is destroyed. | 

According to experiments made by Bayer with employed 
methods of application of cold, the most pronounced action 
resulted from permanent irrigation of a shaved area 
with cold flowing water (water tubes); at the end of one hour 
the temperature had fallen 20°. A spray of ether 
reduced the temperature fifteen degrees in ten minutes; fifteen 
minutes after the spray had been removed the temperature 
had returned to normal. Seven to eight degrees was the 
maximum reduction of temperature from the application of 
ice bags and Leiter’s tubes. The action of cold 
baths and cold bandages is very weak ; when changed 
every five minutes the temperature dropped 3 to 5 degrees in 
favorable cases; ordinarily the temperature drops only dur- 
ing the first two or three minutes and then rises again. 
Cold baths must be frequently renewed, or cold may be 
applied inthe formofastream. Applications of clay, 
which were extensively used at one time are entirely insuffi- 
cient ; like cold baths the temperature is slightly reduced after 
a few minutes, but soon returns nearly to normal. The fol- 


82 MASSAGE 


lowing is an experimental case : the subcutaneous temperature 
was 35.7° C., aclay pack of 12.5° C. was applied, the tem- 
perature sank in five minutes to 32.5° C. In thirty minutes 
it returned to 34.5° C., and after sixty minutes to 34.9° C. 

MassaAGE.—Massage is a very important form of treat- 
ment in subcutaneous, and chronic aseptic inflammation of 
tendons, joints, muscles, bone, and skin. )lti@s 
contra-indicated in septic, infectious, suppu- 
rative inflammations, especially phlegmons, 
as it favors the spreading of the disease pro- 
cess. It is also contra-indicated in painful acute inflamma- 
tions. Four kinds of massage are recognized : 

1. Stroking (effleurage). 

2. Rubbing (friction). 

3. Kneading or malaxation (petrissage). 

4. Tapping (percussion). 

Constant pressure (compression) may also be 
considered a form of massage. The action of massage con- 
sists in the removal of the exudate from the diseased and in- 
flamed tissue; it is mechanically forced into the lymph 
channels and thus prepared for resorption. The distension 
and swelling of the inflammatory enlargement are overcome, 
thus reducing the pain. The circulation, nourishment, and 
innervation are stimulated. 

CUTANEOUS IRRITANTS.—The so-called counter-irritant 
method is of great importance in veterinary science in the 
treatment of chronic inflammations. Blisters and 
firing are the most important, cutaneous irritants. These 
are especially useful in chronic inflammations of the tendons 
and joints, where the results are very satisfactory. Their ac- 
tion is due tothe transformation of a chronic to. 
an acute inflammation, which makes possible the 
resorption of the inflammatory product. The cutaneous 
irritants mentioned produce the following changes in tissues 
affected with chronic inflammation: dilitation of the blood- 
vessels; inflammatory transudation of the blood-serum ; 
migration of the white blood-corpuscles (phagocytosis) ; for- 
mation of ferments (enzymes) out of the white blood-corpuscles, 


AGENTS THAT OPPOSE INFLAMMATION 83 


by which the albumenous bodies inthe chronically inflamed 
tissue are digested in the form of albumenoses (propeptones), 
and the solid products are softened, thus passing into solution 
(histolysis). An actual cutaneous irritant exerts a deep influ- 
ence on tendons, bones, and joints. This has been demon- 
strated by microscopic examination of tissues following the 
application of tincture of iodine to the skin. A few hours 
after the application there occurs an extensive transudation, 
and emigration of the white blood-corpuscles into the skin and 
subcutem, as well as into the intermuscular tissue and perios- 
teum of the underlying bones. These acute inflammations 
may even reach to the bone-marrow and lead to loosening and 
solution of the cartilage at the epiphyses (Volkman). 

AGENTS THAT OPPOSE INFLAMMATION.—AS many in- 
flammations are of an infectious nature they may be effectually 
combated with antiseptics. In the treatment of deep 
inflammations (phlegmon, strangles, tendinitis) antiseptics 
which penetrate the skin must be employed (camphor, car- 
bolic acid, tar, iodoform, mercury, etc.). Other drugs which 
find use are the metallic and vegetable astringents; they 
constrict the blood-vessels, form a protective dry covering, 
and at the same time disinfect (silver nitrate, sugar of lead, 
acetate of lead, alum, sulphate of zinc, lime water, tannin, 
and tannoform). ‘The so-called protective materials have a 
purely mechanical action (oils, salves, collodion, plaster). 
Potassium iodide is a specific for antinomycosis. 

The serum treatment for inflammation and wound 
infection diseases (antistreptococcic serum) has not proved 
satisfactory. 

OPERATIVE TREATMENT OF INFLAMMATION.—In many 
forms of inflammation, especially the infectious (abscess, 
phliegmon, ichorous inflammation), incision with subsequent 
irrigation and drainage is preferable to any other treatment. 
Against chronic hygromata (capped-hock) injections of pure 
cultures of staphylococcus pyogenes have been employed ; this 
results in the formation of an acute abscess which is treated as 
such (?). In gangrenous inflammation the necrotic 
portions must be removed, it may be necessary to 


84 ULCER, FISTULA, GANGRENE 


amputate (tail, teeth, udder, ear, wings, limbs of dogs). 
Other operations are scarification, thatis, the local draw- 
ing of blood by means of incisions or punctures; phle- 
botomy, at the present time this is employed surgically only 
in that form of acute, aseptic inflammation of the pododerm 
known as laminitis. Periosteotomy (artificial accelera- 
tion of anchylosis formation by means of spavin operation ) was 
frequently employed at one time for spavin, and chronic 
periostitis on the metacarpus. 


ULCER, FISTULA, GANGRENE. 
I. ULCER, ULCERATION. 


DEFINITION.—From a surgical standpoint an ulcer may 
be defined as a wound that has no tendency to 
heal (Billroth). It may also be termed a chronic, sup- 
purative inflammation with a tendency to degeneration of the 
tissues ; asa continual suppurative degeneration of the granu- 
lations of the wound. Ulcerative degenerations also exist in 
tumors as a result of suppurative infection of the new growths 
(carcinoma). From a standpoint of pathological anatomy an 
ulcer may be defined as a tissue defect due to necrosis or 
suppuration. 

CausES.—The causes of ulcers are partly local, partly 
general. Two main groups of ulcers are recognized : 

1. A primary and idiopathic ulcer is due to the 
influence of a continuous inflammatory irritant on the wound. 
It may be due to shaking the ears after injuries, constant lick- 
ing of the wound at the point of the tail or on the limbs in 
dogs. Other causes are irritation due to the presence of 
foreign bodies in wounds, retained masses of pus, pieces of 
necrosed bone, cartilage and teeth, continued irritating influ- 
ence of carious teeth on the neighboring gums. 

2. A secondary or symptomatic ulcer is the 
result of a complication with a suppurative inflammation. To 
this form belong cancerous ulcers; thoseof glanders, 
tuberculosis and actinomycosis; the corneal 


FORMS OF ULCERS 85 


ulcers of dog distemper and diabetis mellitus ; and the 
genital ulcers of dourine. 

- The so-called varicose ulcers of man, which occur on the 
tibia, do not exist in the lower animals; they are due to an 
inflammatory vascular engorgement induced by 
a dilitation of the veins of the skin, and are very common. 
On the other hand, the so-called trophoneurotic ulcers, 
which develop in man after severe neural disturbances, are 
‘also seen in the lower animals (corneal ulcers following paralysis 
of the trigeminus). 

Forms OF ULCERS.—According to the character of the 

granulations ulcers are termed indolent (atonic, torpid, 
painless), and irritable (erethistic, inflamma- 
tory, painful). According to the character of the margins 
ulcers are termed smooth and callus, that is, they have wall- 
like, firm, cicatricial margins. With reference to the depth 
they may be superficial, deep, or sinuous (sinuate, 
undermined), or tube-shaped and fistulous (fistula). 
Superficial ulcers on the mucous membranes are termed 
catarrhal or erosion ulcers. According to the character 
of the surface of the ulcer it is termed hemorrhagic, 
ichorous, gangrenous, necrotic, diphtheritic, 
_fungoid, (hypertrophic, luxuriative), and phagadenic 
(cancerous, increasing rapidly indiameter). Serpiginous 
ulcers (creeping) are those which move from place to place, 
healing in one place and extending in another. The following 
classification is made with reference to the size: miliary 
(size of a millet seed), lenticular (size of the crystalline 
fens), those the size of peppers, peas, dollars, etc. 
With reference to the form, ulcers may be round, oval, or 
irregular. 

TREATMENT.—Many ulcers heal simply asa result of 
rest, that is, after the removal of the irritating cause. 
Ulcers at the ends of dogs ears, for example, heal after the 
application of a bandage or ear-cap which prevents the shaking 
of their ears. The same is true of ulcers at the point of the 
tail, on the extremities, and on the eyes ( cocaine). 

Other methods of treatment are extirpation, cur- 


86 FISTULA 


rettage, firing, or cauterization; they are thus 
transformed into fresh wounds. The application of such 
agents as the knife, curet, cautery, chloride of zinc, sublimate, 
chromic acid, and other caustics is preferable to the use of 
weaker antiseptics and irritants. 

Iodid of potash is an internal specific for actinomy- 
cotic erosion ulcers of the oral mucous membranes ; necrotic 
ulcers due to a general diseased condition may be treated with 
arsenic. Ulcers of glanders are not treated. 


THE MOST IMPORTANT ULCERS IN DOMESTIC ANIMALS.—Ulcers. 
of surgical importance are far less common in animals than in man. 
The following are of practical importance : 

I. Ulcers atthe point of the ear in dogs. 


2. Ulcers. atthe point of the tail in dogs and cattle. 

3. Corneal ulcers in dogs affected with distemper. 

4. Hoof ulcers in horses (sole or wall). 

5. Decubital ulcers asa result of lying. 

6. Stomatitis ulcers in dogs. 

7. Cancerous ulcers with carcinoma of the skin in horses 


and dogs. 
8. Ulcers ofthe tongue and lips in horses and cattle. 
Also, many badly granulating wounds, as well as many treads 
on the coronet, and pressure injuries inthe region of the 
saddle, on the withers and on the neck of the horse, may be considered 
as ulcers, 


Lt BIST UA 


DEFINITION.—In surgery many diseases are recognized 
under the term fistula. One must differentiate between two 
different processes. ; 

1. Pus fistulae may be regarded as tube-like or 
sinuous ulcers; they result from inflammatory suppurative 
foci that form in the depths of the skin, subcutem, muscles, 
bone, cartilage, and glands, and which reach the surface by a 
process of gradual ulceration (Billroth). ‘They are, there- 
fore, the product of a chronic, suppurative, destructive inflam- 
mation in the depths of the tissues. The inflammation is 
frequently sustained by the presence of fragments of necrosed 
tissue (cartilage, bone), occasionally it is supported by the pres- 


PUS FISTULAE 87 


ence of specific microorganisms (botryomyces); the suppurative 
exudate being discharged through a tube-shaped canal. The 
following are examples of fistulae ; fistula of the lateral 
Saas, fistula of .the ‘spermatic *cord} 
tooth fistula, fistulous withers, poll-evil, 
porebotomy fistula, fistula,of the fetiock, 
coronary fistula, gluteal fistula, sternal fis- 
tula, pelvic fistula, costal fistula, and other 
Dome 1istulae. 

2. Secretion and excretion fistulae imply a 
pathological relation of deeply seated secretory organs (glands) 
and excretory organs (stomach, intestines, bladder) with the 
external surface of the body. Tothisclass belong salivary 
fistulae, lachrymal fistulae, milk fistulae, 
gastric fistulae, intestinal fistulae, ear fistu- 
jae, and fistulae of the uterus. They are due, 
either to traumata, and inflammations (acquired fistu- 
lae), or they may havea congenital origin (ear fistula, 
fistula of the intestines, urinary fistula). When the canal has 
a free communication with the excretory organ and the exter- 
nal surface it istermed a complete or communicating 
fistula, when the canal ends in the tissues it is termed a 
blind fistula. According to the form of the fistulous 
tract it is termed a canal, funnel, or lip-shaped fistula. Other 
forms are skin, mucous membrane, corneal, serous, and tendon- 
sheath fistulae. 

Pus FistuLan.—The symtoms of pus fistulae are 
variable according to their location. The fistulous opening is 
about the same in all forms; it is usually small, constricted, 
indurated, pus in various quantities is discharged from it. 
The walls of the canal may be hard or smooth; occasionally 
itis filled with torpid granulations. At the bottom of the 
canal one can usually feel a rough, hard mass of tissue 
(necrosed piece of cartilage or bone). Fistulae are usually 
painless, as they are the product of a chronic inflammation. 
They may, however, become complicated with an acute in- 
flammation—an acute phlegmon for example—under the influ- 
ence of an injury or an improper operation. 


88 . SECRETION AND EXCRETION FISTULAE 


The treatment of pus fistulae is analagous to that of 
ulcers. The suppurative ulcerative, and badly granulating 
walls of the smooth, indurated and encapsuled fistulous tract 
are transformed into clean wound surfaces. One should be 
particular to remove the necrosed tissue at the fistulous canal. 
An operation, therefore, is the best treatment for a pus 
fistula ; open freely to the bottom, remove the necrosed tissues 
(cartilage, bone, teeth), extirpate the indurated walls and 
remove the granulations. For this purpose one may use the 
- scalpel, scissors, curet, bone-forceps, chisel, etc. To merely 
split the fistula.or cut around it, 1s aS 
insufficient. After splitting, the essential treatment is 
unperformed : this consists in the removal of the chronically 
inflamed fistulous walls, and the ulcerative surfaces at the 
bottom. When operating a pus fistula strict 
antisepsis is necessary to prevent infection 
of the fresh wound surface from the old sup-. 
purative foci. When these principles—upon which Bayer 
placed special emphasis—are not observed, or when splitting 
of the fistula is not followed by careful removal of the necrotic, 
pus-infiltrated tissue; the operation is easily followed by an 
acute suppurative infection of the previously healthy tissue, an 
extensive phlegmon is especially liable to occur. One should 
observe the converse precaution: that, frequently, the 
operative removal ofa fistula appears to be 
contra-indicated as long as there is an acute 
phlegmonous inflammation inits vicinity. In 
such cases the operation must be deferred until the phlegmon 
has subsided. Moller placed special emphasis on this surgical 
principal in the operative treatment of fistula of the lateral 
cartilage, it is mecessary to coincide with his view on this 
subject. 

When a fistula cannot, or should not, receive operative 
treatment it may be fired or cauterized, an operation 
is more rapid and effectual. The mere application of 
antiseptics is seldom effective. . 

SECRETION AND EXCRETION FISTULAE.—These are 
readily distinguished from pus fistulae by the fact that, instead 


PUS FISTULAE 89 


of pus, various secretions and excretions are discharged from 
the opening ; saliva, milk, urine, food, gastric contents, intes- 
tinal contents and feces. Their healing is much more 
difficult than that of pus fistulae. The conditions 
which producean unfavorable prognosis are: continual pres- 
sure from the discharging glandular secretions, operations on 
the stomach and intestines (gastric fistula, intestinal fistula) 
lead to an opening of the abdominal cavity, when a fistulous 
process exists this is doubly dangerous. Operations intended 
to bring about removal of secretion and excretion fistulae are 
of a plastic nature, they consist in an artificial scarification 
and suturing of the fistulous openings. Firing and caustics 
are seldom effective. In many cases radical treatment is the 
only method of healing secretion fistulae, such as extir- 
pation of the secretory gland (extirpation of the 
parotid in the horse). 


THE Most IMPORTANT Pus FISTULAE IN DOMESTIC ANIMALS.— 
The following are of practical importance: 


1. Fistula of the lateral cartilage inthe horse. This is 
a circumscribed necrosis of the cartilage which usually develops from a 
parachondral phlegmon and induces a chronic ulcerative condition with 
one or more fistulous canals leading to thecoronet. Treatment: Extirpa- 
tion of the lateral cartilage (Bayer’s method). 

2. Fistula of the spermatic cord ‘in the horse is due to 
a chronic, suppurative, indurative inflammation of the spermatic cord 
(funiculitis chronica) and the tunica vaginalis. It is caused partly by 
the botryomyces fungus (botryomyces of the spermatic cord), partly by 
ordinary pus cocci. Treatment: Extirpation of the degenerated sper- 
matic cord (ligature, emasculator, ecraseur). 

3. Tooth fistulae occur in horses, especially on the premo- 
lars of the inferior maxillae; in dogs they are more frequently seen on 
the upper jaw. They are the result of a suppurative alveolar periostitis, 
ostitis, and osteomyelitis. Treatment: Extract the tooth. 

4. Bone fistulae develop from a suppurative, especially 
necrotic, periostitis, ostitis, and osteomyelitis. According to their seat 
they are classified as follows: sternal fistula, pelvic fistula, costal fistula, 
inferior maxillary fistula (false tooth fistula), fistula of the tail, fistulae 
of the round bones, etc. Treatment: Removal of the necrotic piece of 
bone (sequester) by means of chiseling, trepanation, curettage, and 
firing. Because of the deep seated position of the bone sternal fistulae 
heal with great difficulty. 

5. Fistulous withers and poll-evil exist in the horse as 


ele) SECRETION AND EXCRETION FISTULAE 


a result of contusions; the contusions are followed by phlegmon and 
necrosis of the skin, subcutem, bursae, fasciae, muscles, and bones, on 
the withers, in the saddle position, and in the region of the neck. 
Treatment: Operative removal of all necrotic portions, antiseptic drain- 
age and irrigation. 

6. Phlebotomy fistulae are supported by a suppurative thrombo- 
plebititis of the jugular vein. Treatment: Double ligation and extirpa- 
tion of the diseased vein. 

THE MOST IMPORTANT SECRETION AND EXCRETION FISTULAE.— 
The following are of practical importance: | 

1. Milk fistulae in cows are due to injuries, followed by in- 
flammation of the udder and abscess formation; they usually occur 
during lactation; occasionally they are congenital. One distinguishes 
between a fistula of the gland and one that leads to the milk duct. 
Treatment: Scarification and suturing, firing, cauterization, application 
of a milk catheter, healing is often possible only during the dry period. 

2. A salivary fistula is due, either to an injury from without 
(wounds), or within (salivary calculi), it may be either a fistula of the 
gland orduct. Treatment: Ligation, scarification and suturing, firing, 
extirpation of the gland, injection of caustics. 

3. Kar fistula (cervical fistula, cervico-branchial fistula) in the 
horse is a congenital branchial-cleft teratoma at the base of the ear, 
which contains a tooth (tooth-follicle cyst, erratic tooth). Compare 
with the chapter on teratomata. Treatment: Extirpation. 

4. Pharyngeal and esophageal fistulae are due to 
external and internal injuries, as well as to perforating abscesses. 
Treatment: Suture. 

5. Gastric and intestinal fistulae are the result of ex- 
ternal and internal penetrating wounds. According to the seat, and 
species of animal they are classified as follows: Fistula of the 
abomasum, rumen, reticulum, small intestine, large 
intestine, and rectum. A very large intestinal fistula is termed 
anus praeternaturalis—artificial anus—; vagino-rectal fistula is 
termed cloaca (anus vaginalis, recto-vaginal fistula) ; a fistula uniting 
the bladder and rectum iscalled an anus vesicalis. Treatment: 
Plastic operation. | 

6. Cysticand urethral fistulae are both termed uri- 
nary fistulae. They are acquired (traumatic) or congenital. The 
following are special forms: vesico-vaginal, vesico-rectal, 
and vesico-intestinal. In a fistula of the urachus 
(dropping of urine from the navel) the urine discharges continually 
from the urachus because the fundus of the bladder is not closed. 

Other forms of fistulae are lachrymal fistulae, corneal 
fistulae, fistulae between the oral and nasal cavities. 


GANGRENE OI 
III. GANGRENE. NECROSIS. 


DEFINITION AND Kinps.—The term gangrene (necrosis, 
mortification ) indicates death of groups of tissues, as well as 
local tissue death. Insurgery various kinds of gan- 
grene are recognized, in especial, dry gangrene (gan- 
graena sicca) or mummification, and moist gangrene 
(gangraena humida) or maceration (liquefactive degene- 
ration). When accompanied by symptoms of inflammation it 
is termed hot, otherwise, cold gangrene (sphacellus). 
The colonization of putrefactive organisms (saprophytes) on 
moist gangrene resultsin putrid gangrene (putresence). 
Ichorous or phagedenic (phagedena) gangrene is 
termed putrid, progressive gangrene. Gas gangrene 
(gangrenous emphysema) is caused by a mixed infection with 
gas-producing bacteria (bacillus phlegmonae emphysema- 
tosae, gas-generating varieties of bacterium coli). A circum- 
scribed bone necrosis is termed a sequester ; certain lique- 
factive processes on the bones and teeth are termed caries. 
Gangrene of the mucous membrane is termed diphtheria. 
Superficial, dry, gangrenous areas are termed eschars. 
So-called coagulation necrosis isa special anatomical 
form of gangrene. 

One further differentiates: gangrene of the skin, podo- 
derm, subcutem, bone, muscles, tendons, mummification and 
maceration of the fetus, a circumscribed and progressive, an 
infectious and non-infectious (septic and aseptic) gangrene. 

CAUSES OF GANGRENE.-—1. Mechanical inter- 
ruption of the circulation is one of the most fre- 
quent causes of gangrene. Uninterrupted compression, or that 
which is combined with destruction of the tissues (pressure, 
contusions, strangulations, incarcerations) causes gangrenous 
death as a result of anaemia, especially when combined with 
injuries to blood-vessels (pressure necrosis, decubitis). The 
statement has already been made. under contusions, that 
mechanical destruction, alone, does not result in cellular death. 
Ligatures, thrombus formations, emboli, as well as diseases of 
the walls of arterial vessels produce results similar to those of 


92 CAUSE OF GANGRENE 


compression ; they cause an interruption in the exit of ‘the 
venous blood (anaemic necrosis). Death of the skin 
and muscle occurs in from ten to twelve hours after the circu- 
lation has been stopped; anaemic necrosis of the intestines 
follows complete interruption of one or two hours (incarcerated 
hernia). Bone and cartilage are the least sensitive. Derange- 
ment of the circulation due to hyaline thrombosis of the 
branches of the peripheral arteries may result from gangrene 
(mummification of the extremities) due to ergot-poisoning 
(ergotism ). 

2. Chemical causes of necrosis include the caustics. 
Their action is variable. The metallic caustics (sublimate, 
chloride of zinc, chromic acid, sulphate of copper) destroy the 
tissue cells through the formation of a precipitate of metallic 
albumenates, and freeing of the acid compounds. ‘The caustic 
acids (nitric acid) produce an eschar formation through the 
coagulation of albumen ; they also destroy cells by absorption 
of water (sulphuric acid). The alkalies (caustic potash, lime, 
ammonia) transform the albumen of the tissues into a slimey, 
pulpy mass (alkali albumenate). Formaldehyde produces a 
dry, horn-like, very deep necrosed area. Snake poisons, as 
well as many infectious materials, may produce necrosis by 
their chemical action. 

3. The following thermic influences are classified 
as causes of necrosis: high degree of heat (burning, com- 
bustion), and cold (freezing, frost-gangrene, 
congelation). The so-called third grade of burning and 
freezing is nothing but necrosis. ‘There is a great difference 
in the susceptibility of different tissues to thermal influences, 
a loop of intestine, for example, dies in a few hours when ex- 
posed to an increased temperature of 8° C. 

4. Many infectious irritants cause so-called 
gangrenous inflammations. Death of the tissues is 
due partly to the chemical action of bacterial toxins, partly to 
their derangement of the circulation. The ordinary pus- 
forming bacteria—streptococci and staphylococci— 
have the ability during the course of a suppurative inflamma- 
tion, namely, phlegmon, to produce necrosis (necrosis of the 


“ 


* 


NECROSIS BACILLUS 93 


lateral cartilage during the course of a parachondral phlegmon),. 
The necrotic action of the following septic bacteria is especially 
Srebe  mecrosis bacillus, anthrax bacillus, 
blackleg bacillus, edema bacillus, gilanders 
bacillus, the bacteria of hog cholera, swine 
plague, eas Swine erysipelas (necrosis of the skin 
in swine), uae tan te Cf Loot Ot, gang tenous. 
eczema, gangrenous pox, the. so-called gan- 
grenous erysipelas of sheep and swine, infec- 
tious diseases that are characterized by diptheria of the 
mucous membranes, as well as many cases of pete- 
chial fever in the horse (necrosis of the skin, mucous 
membranes, the nasal septum, the prepuce, and even the 
articular cartilage. ) 

Also many fungi (necrosis fungi), especially tilletia 
caries, ustilago carbo, ustilago maidis, and polydesmus exi- 
tiosus, produce necrosis on the skin and mucous membranes of 
cattle, horses, and sheep. The buds of buckwheat seem to 
produce gangrene in a similar manner (fagopyrismus), the 
same is true of lupinosis in horses, and clover-disease, as well 
as the so-called gangrene of white spots. Necrosis of the skin 
and mucous membranes has been observed in the horses ot 
Batavia as a result of the colonization of a mould (hyphomycosis 
destruens equi). 

Beurrequently © several causes are operative 
at the same time. Pressure necrosis in horses 
and cattle may follow relatively slight mechanical insults when 
a severe general disease exists at the same time. This is 
especially true of diseases of the circulatory apparatus (fever, 
septicemia, diseases of the blood, anaemia, cachexia, cardiac 
diseases, general exhaustion). The following types of gan- 
grene present similar conditions: gangrene of old age (gan- 
graena senilis), the so-called sugar gangrene (gan- 
graena diabetica), and that which follows diseases of 


the spinal marrow, so-called symmetrical gangrene. 
NEcROsIS BACILLUS.—Under this name Bang described a bacillus 
that had already been observed by LOfflerand Schmorl; it occurs 
in a great number of disease processes, partly as a cause, partly as a 
concurrent symptom (mixed infection). It is an ubiquitous bacterium, 


94 SYMPTOMS 


especially in the intestinal contents, the feces, in dust and 
dirt; in the tissues it causes coagulation necrosis, and diph- 
theritic, ulcerative degenerations. It belongs to the 
filiform bacteria (‘‘streptothrix necrophora’’), and develops, partly in 
the form of rods, partly as a coccus, and partly in the form of long 
filaments—as long as Ioo microns; on staining it presents clear, round 
or cylindrical spaces. It is an anaerobe, non-motile, and without 
flagellae (Ernst). With Loefflers solution of methyeline blue or carbol- 
methyeline blue, recognition is easy; it is decolorized by Gram’s 
method. It grows best in coagulated serum as well as in semi-solid 
media at 39° C. House mice are specially sensitive to inoculation ; 
after subcutaneous injection there develops an extensive necrosis 
of the tissues, which results in death in the course of a week. The fol- 
lowing conditions are caused by subcutaneous injections into the ear of 
a rabbit; extensive necrosis with thrombus formation in the large 
veins, embolic foci in the lungs, secondary pleuritis, occasionally 
necrosis in the heart and other organs. Injections in cattle, sheep, and 
swine result only in local swelling and abscess formation (Ernst). 
Bang and Jensen have found the necrosis bacillus in the following 
places: 

1. In the HORSE as a cause of gangrenous dermatitis 
(grease), fistulae of the lateral cartilage, coronary fis- 
tulae, and in diptheria of the mucous membrane of the 
colon. : 

2. In CATTLE asacause of panaritium, gangrenous pox, 
diphtheria of the uterus and vagina (also demonstrated by 
Ellinger), in mecrotic inflammation of granulating 
wounds,in calf diptheria, in necrosis nodosa multiplex of the 
liver, abscesses of the liver, and embolic necrosis of the lungs and heart. 

3. In SWINE in necrosis of the skin, diphtheria of the 
nasal mucous membranes and oral mucous mem- 
branes, as well asin necrotic foci of intestines and lungs in swine 
plague. 

4. In RABBITS Schmorl has observed a contagious, progressive, 
necrotic inflammation caused by the necrosis bacillus. It was ushered 
in with pronounced swelling of the head (under lip) which extended to 
the neck, thorax, and abdomen, and terminated fatally in from 12 to 16 
days. 

SyMpToMS.—Dry gangrene is characterized by dryness 
of the dead tissues. The necrotic skin appears to be covered 
with dried secretions, itis scabby, leathery, parchment-like, 
sometimes as hard‘as horn, from brown to black in color, cool 
and non-sensitive. Dry gangrene is most often seen in the 
following places : on the back from saddle pressure, decubital 


SYMPTOMS 95 


gangrene on the external angles of the ilium, zygomaticus, 
etc., at the point of the tail in dogs, on the claws of cattle, on 
the cornea, following cauterization with nitric acid and formal- 
dehyde, after death and drying of the fetus in the uterus 

(mummification ). | 

Moist gangrene presents the following symptoms: the 
necrosed tissue has the appearance of a slimey, soft, slushy, 
pulpy or ichorous, bloody mass; in color it may be grayish- 
yellow, grayish-brown, dark-yellow, dark-brown, brownish- 
green, grayish-green, violet, or black. A necrotic lateral 
cartilage is of a beautiful light-green color (bacteria which 
form coloring matter). The necrotic masses of tissue are 
usually cool and non-sensitive (cold gangrene). When inflam- 
mation exists at the same time they have a warm sensation 
(hot gangrene). Stinking, putrid gases occasionally develop 
in the dead tissues (sulphide of hydrogen, hydrocarbons, 
hydrogen, ammonia, carbonic acid), they cover the external 
skin in the form of blisters, or produce a frothy condition of 
the ichorous mass (gangrenous vesicles, gangren- 
ousemphysema, emphysema septicum). 

The gangrenous dead part is separated from the sound tis- 
sue through a reactive, suppurative inflammation under the for- 
mation of granulation tissue(demarkinginflammation, 
line of demarcation, zone of né&crosis). When 
the gangrenous process extends to the walls of the large ves- 
sels it may result in a gangrenous erosion of the 
vessel-wall and lead to severe arterial and venous hemor- 
rhage. The general condition isalso frequently affected (septic 
and pyemic affection). 

Moist gangrene is most often found during the course of 
septic phlegmons, on the pododerm, coronet, flexor surface of 
the fetlock (gangrenous eczema), in the saddle, withers and 
neck region, on the lower parts of the extremities, on the 
inferior margin of the lower jaw and tongue in the horse; 
on the udder of the cow, sheep and goat, on the scrotum and 
tail of cattle and dogs, as well as on the fetal membranes 
(putrid degeneration following retention), and in the fetus 
(putrid emphysematous and macerated fetus). 


96 TREATMENT 


TREATMENT.—Treatment of necrosis consists in oper- 
ative removal of the necrosed part (knife, scissors, 
curet, forceps, chisel, trephine, etc); occasionally amputa- 
tion of an entire organ of the body is necessary (tail, end of 
the tongue, penis, udder, claws, ears, limbs of dogs). Slough- 
ing of the dry gangrenous masses may follow the application 
of antiseptic cataplasms. Above all, thorough and con- 
tinuous disinfection is necessary. ‘To prevent decubitis 
in horses and cattle use plenty of soft bedding (tan-bark, sand). 


ATROPHY.—Atrophy isa reduction in the size of organs, as well 
as individual cellular elements; it is due to deranged nutrition and 
pathological retrogression. (Aplasia is complete failure of organs, the 
testicles, forexample). From an etiological standpoint the following 
kinds of atrophy are recognized in surgery : 

1. Atrophy of inactivity is the result of inactivity of 
organs, especially the muscles and glands. The cells, because of inac- 
tivity, cease to assimilate (active atrophy). Compare with chronic 
lameness in the horse that is usually accompanied by active muscular 
atrophy, as well as atrophy of the penis in phimosis (high urinator). 

2. Pressure atrophy is the result of continued compression of 
organs, for example, from new formations (passive atrophy). This is 
seen on the os pedis as a result of keratoma. . 

3. Degenerative atrophy is due to deranged nutrition accom- 
panying the course of an inflammatory process, for example, in the 
udder and eye (atrophy and phthisis bulbi in moon blindness and sup- 
purative panophthalmia); in muscular inflammation of the quadriceps, — 
anconeus, and longissimus dorsi (inflammatory atrophy ); it 
may also follow paralysis of the nerves, for example, the suprascapularis 
(muscles on the external surface of the scapula), the trigeminus (mus- 
cles of mastication), the spinal marrow (posterior limbs) (neurotic 
atrophy). This is not usually a form of simple atrophy; degenera- 
tive changes usually occur. Other forms are senile atrophy, the so- 
called lipomatous atrophy of the muscles (obesity), and the udder 
(fleshy udder). For further data concerning atrophy compare with the 
chapter on diseases of the muscles and bones. 

ATRESIA. OBLITERATION.—These terms indicate the closure or 
growing together (adhesion) of body openings and canals. 

I. Atresia is a congentital malformation. It occurs 
in animals in the following places: rectum (atresia ani), on the eye lids 
(atresia palpebrarum), in the milk canal and milk cystern, as 
well as in the lachrymal duct. 

2. Obliteration is an acquired cicatricial adhe- 
sion; it results fom wounds andinflammatory processes 


STENOSIS 97 


in the vagina,on the vulva on the sphincter ofthe teat, in the com- 
missure of the lids, as well as in the vessels in thrombus formation, 
which terminate in aform of cicatrization. In the female genital canal 
there occasionally occur adhesions in the vulva and vagina after injur- 
ies during coitus and parturition. Adhesions at the mouth of the teat 
and in the milk cystern with the formation of folds in the walls are more 
common; they are caused by injuries, eczema, contagious aphtha, and 
catarrhal mastitis. Treatment of atresia and cicatricial adhesions is 
operative (perforation, teat probe, milking tube, bougies). 

STENOSIS.—Stenosis is a narrowing of the canals and cavities of the 
body, especially the following: esophagus, trachea, urethra, vagina, in- 
testines, milk ducts, salivary ducts, nasal cavities, maxillary sinuses, the 
frontal sinuses, and intestines. According to the cause the following 
forms of stenosis are recognized : 

I. Compression stenosis. This is due to pressure of new 
formations or abscesses from without on neighboring canals; for ex- 
ample, the trachea (goitre) ; on the esophagus (tuberculous new forma- 
tions in its vicinity) ; on the rectum (paraproctal abscesses and new 
formations, tumors of the prostate). 

2. Obturation stenosis consists of a narrowing or stenosis. 
of the canal from within through foreign bodies or new formations. 
Examples of this are: obliteration of the esophagus from the retentiqn 
of food (pieces of turnips or potatoes); obstruction of the urethra by 
calculi; of the salivary duct by salivary calculi; of the intestines by 
intestinal calculi; narrowing of the lumen of the trachea after fracture 
of its cartilage (infraction) ; stenosis of the teat canal in cattle from 
wart-like new formations, connective tissue, and epithelium, frequent 
ring-like growths of the mucous membrane (so-called hard milkers) ; 
stenosis of the lachrymal duct as a result of catarrhal swelling of the 
mucous membrane ; stenosis of the nasal, frontal,and maxillary cavities 
by new formations by which they are occasionally entirely filled ; 
stenosis of the external auditory canal in dogs by papillomata. 

3. Cicatricial stenosis or stricture is due to a cicatricial 
retraction following a previous injury or inflammation. Itisseenin 
the trachea after tracheotomy, in the esophagus after esophagotomy, in 
the urethra after urethrotomy, in the vagina following injuries due to 
coitus and parturition, in the teat canal as a result of wounds and chronic 
inflammation (chronic mastitis), in the false nostrils following injuries 
with a severe loss of substance. 

4. Congenital stenosis is seen, especially in cattle, in the 
teat canal and at the passage from the milk cystern to the teat canal ; 
occasionally all four teat canals are abnormally narrow (hard milkers). 
In cows one also occasionally finds congenital stenosis of the vagina 
(dystocia). A similar condition is observed in the lachrymal duct of 
the horse, 


98 TUMORS 


Spasmodic stenosis is very uncommon (spasmodic contraction 
of the esophagus). 

EcrasiA. DILITATION.—These terms indicate an enlargement of 
canals and body-cavities ; the condition is exactly opposite to that pro- 
duced by stenosis. According to the anatomical form the following 
varietiesare recognized: diffuse and circumscribed (diverticu- 
lum), cylindrical, spindle-shaped, and sac-like. There 
is also a genuine anda false ectasia. From an etiological stand- 
point the following are recognized : 

I. Pulsion-—diverticulum formed by outward pressure from 
an object within’ the canal: food above a stenosis of the esophagus 
retained urine froma stenosis of the urethra. Here also belong dilita- 
tions of the cavities of the head in hydrops. 

2. Traction-diverticulum is due to a retracting cicatrix 
from without. To this class belong macrostomia as aresult of extensive 
injuries to the angles of the mouth. 


TUMORS. 
I. GENERAL CONSIDERATIONS. 


DEFINITION.—From a surgical standpoint, in a restricted 
sense, one usually understands a tumor to be an atypi- 
calnew formation not the result of inflamma- 
tion; it has no assignable cause nor physio- 
logical termination; it has no *anatoueeee 
type, that is, it varies from the ty pe © temgmeaee 
from which it develops (Cohnhéim, i) igs 
This definition does not include the inflammatory new forma- 
tions of tissue (hyperplasia), or the so-called infectious granu- 
lation tumors (tuberculosis, actinomycosis, botryomycosis, 
glanders). A complete understanding of the nature of tumors 
has not yet been acquired. 

CLASSIFICATION.—From a clinical standpoint one first 
differentiates between malignant and non-malignant 
tumors. Carcinoma and sarcoma belong to the malignant 
type. They are malignant for the following reasons: they 
develop rapidly with a destruction of the neighboring tissues, 
they have a tendency towards ulcerative degenerations, and 
they are especially distinguished for the formation of metas- 
tases in distant organs. ‘The metastatic formations are pro- 


CONNECTIVE-TISSUE TUMORS 99 


duced in the following manner: small portions of the tumor 
{cancer cells) first enter the lymph-channels (locai lymph 
gland metastasis) and from there find their way into the 
blood-stream (general metastasis of the lungs, liver, and other 
internal organs). Occasionally the cancer cells enter directly 
into the veins that are located in the tumor (jugular) and 
thereby gain entrance to the blood-stream. Aside from meta- 
stasis, malignant tumors may spread by continuity, contiguity, 
and dissemination (proximity, contact, becoming detached 
and forming new colonies). 

The histological classification of tumors depends 
upon their microscopic condition. Tumors are composed of 
cells, connective tissue, and blood-vessels. Various groups 
and varieties have been formed with reference to the cells 
which goto make up the principal parts of the tumor. Fol- 
lowing this classification according to Waldeyer they fall 
into two large groups: 

I. CONNECTIVE-TiIssuE Tumors, (desmoid growths 
of Waldeyer, histoid growths of Virchow). ‘They 
are composed principally of cells from the middle germ 
layer. They may possess the structure of connective 
tissue (fibroma, sarcoma), of fatty tissue (lipoma), mucous 
tissue (myxoma), cartilage (enchondroma), bone (osteoma), 
muscles (myoma), the vessels (angioma), or the nerves (neu- 
roma). Frequently these tumors have no typical structure, 
but are a mixture of various types, so-called mixed tumors. 

2. EPITHELIAL Tumors, (epithelial growths of 
Waldeyer, organoid tumors according to Virchow). 
They are composed principally of epithelial cells from the 
inner or outer germ layer. Carcinomata and adeno- 
mata are the principal representatives of this group. 


HISTOLOGICAL CLASSIFICATION OF TuMORS.—Virchow divided . 
the tumors in general into extravasation or exudation tumors 
(hematoma, hygroma), retention tumors (mucous cysts, athero- 
mata) and proliferative tumors, or tumors in the narrow sense. 
The tumors, in the narrow sense, regardless of whether they contained 
one or several varieties of cells, were classified by him as follows: (a) 


I0Oo CAUSES. 


HISTOID tumors: fibroma, lipoma, enchondroma, osteoma, myxoma, 
myoma, neuroma, angioma, sarcoma; (b) ORGANOID tumors: carci- 
noma; (c) TERATOID tumors: dermoid cysts. 

Cohnheim, with whom Tillman and others coincide, distin- 
guished : (a) tumors formed according to the type of connective- 
tissue substance (desmoid tumors according to Waldeyver): 
fibroma, lipoma, myxoma, chondroma, osteoma, angioma, lymphan- 
gioma, endothelioma, lymphoma, sarcoma, and mixed tumors of the 
types named ; (b) tumors of the type of muscle tissue (myoma); _ 
(c) tumors of the type of nerve tissue (neuroma, glioma); (d) 
tumors of the type of epithelial tissue (epithelial growths ac- 
cording to Waldeyer): carcinoma, adenoma, cystoma, epithelioma, 
onychoma, teratoma. 


CausEs.—Nothing definite is known concerning the 
origin of tumors. Among the numerous theories of 
tumors the following are worthy of mention. 

1. According tothe EMBRYONIC THEORY of Cohn- 
h ei m the existence of tumors,especially cancer, may be referred 
toproliferation of embryonic tissues; thereisan 
excessive formation of this tissue during fetal development, or 
an aberration of its physiological coherence whereby it is 
changed into other tissue. These embryonic cells remain un- 
developed in most individuals; in others growth may be 
stimulated as a result of injuries, mechanical or chemical irri- 
tants, hyperemia, or inflammation.The inheritance of many 
tumors, as well as the existence of desmoid cysts in the inner 
organs (misplaced epidermal cells in the ovaries), are best 
explained by this theory. Ribbert has modified the theory 
as follows: the cells or cell groups loose their cohesion, not 
only before but also after birth, become isolated and finally 
develop into tumors. | 

2. The IRRITATION THEORY depends upon a previ- 
ous inflammation, as well as traumatic influences. The exter- 
nal irritant causes a mechanical loosening of the cells and results 
in an inflammatory proliferation of the connective tissue. The 
detached cells (epithelial cells for example) may proliferate un- 
restrained into the lymph-spaces. Chemical irritants and para- 
sites also cause loosening of the cells through the production 
of connective-tissue proliferations ; the cells become isolated 
and proliferate. The development of papillomata after inflam- 


ETIOLGY OF TUMORS IN ANIMALS IOI 


mations of the skin, of sarcomata after bone fractures and of _ 
cancers from a cicatrix, are cited as examples of this method of 
tumor formation. 

Be According to the INFECTION. THEORY, either 
microorganisms are the direct or essential causes of the tumor 
(carcinoma, sarcoma, papilloma), or through certain influences 
the sound tissue cells take on an infectious character. The infec- 
tion theory is supported by the analagous infectious tumors : 
experimental inoculation (sarcoma, carcinoma), as well as by 
the process of metastatic formation. Unobjectionable 
proofoftherelations between microorganisms 
woartumors has not yet been presented; this is 
especially true of sarcomata and carcinomata. 

4. According to the AGE THEORY of Thiersch, age 
has the following relation tothe existence of tumors: In old 
meerthe resistance of the connective-tissue 
Beeroma is less than that of the proliferating 
Pronenial cells. Cancer is the result of a ‘‘shifting of 
boundaries, and a boundary war of the epithelium against the 
connective tissue’’ (Boll). The change of the cell char- 
acter (anaplasia), duetoa stimulus of the prolif- 
erative force of the cells, results from the fact that in 
old age the dependence of individual cells upon their sur- 
roundings (altruism) is diminished; they become similar to 
the original, non-differentiated germinal cells (Hanse- 
mann). For further information concerning the etiology of 


cancer compare with the chapter on carcinoma. 

ETIOLOGY OF TUMORS IN ANIMALS.—Upon this subject little is 
known. Many theories of medical science find place, with nothing 
further to support their claims, in veterinary science. Thus Plicque 
maintains that pressure from the bit causes carcinomata on the lips 
of horses; that they are caused in cats by the repeated bites of smaller 
animals (!!). In Germany these observations have not yet been made. 
Also the further theory, that subcutaneous fibromata are often the 
result of pressure from the saddle does not seem to be proved, it is not 
a genuine tumor, but a contused swelling (tumor fibrosus). Smith 
and Washburn attempted to produce infection in eleven bitches by 
means of coitus with a dog affected with sarcoma of the penis; it is 
alleged that the experiment resulted in sarcomatous nodules in the 
vagina. They have also transmitted sarcoma to other animals by means 


102 CLINICAL SYMPTOMS 


of subcutaneous injections (?). With reference to the professed. 
heredity of melanoma in horses, and cancer of the mammae in dogs, 
nothing definite is known. On the other hand, on the basis of my own 
experience, I am able to confirm the allegations of Plicque, that 
young dogs seldom or never suffer from carcinomata, while old dogs are 
frequent sufferers from this affection. In at least 262 carcinomata in 
dogs I have never seen one in an animal less than two years of age. 
Also the 49 cases of carcinomata claimed to have been demonstrated in 
cattle (inner canthus of the eye) by Loeb and Jobson were con- 
fined exclusively to animals over six years of age. With reference to. 
the influence of nourishment it may be said that animals fed on a 
meat diet are possibly predisposed to carcinoma. According to our 
experience dogs suffer from cancer more often than swine or cattle. 
Carcinomata are also common in horses. The claim of Trasbot, that 
cancer can be experimentally produced by feeding nourishment rich in 
albumen, is more than problemetical (compare with the chapter on car- 
cinoma). 

CLINICAL SymptToms.-—According to the character of the 
tumor and the various stages of its development, these are 
extremely variable. Cf: ‘‘Special Forms of Tumors.’’ The 
development may be rapid or slow; it may proceed from the 
center of the growth (concentric development, growth by in- 
tussusception) ; or from the periphery (eccentric growth, 
growth by apposition). In the first case the tumors are cir- 
cumscribed, in the latter they are diffuse or accompanied by 
daughter tumors. Tumors are often observed undergoing 
changes known as regressive metamorphosis; 
_namely, fatty degeneration, caseation, calcification, cornifica- 
tion, chondrification, and ossification, mucous, colloid, and 
cystic softenings, deposits of cholesterin, amyloid degenera- 
tions, and pigment formation. When tumors become infected 
they react as do other tissues, becoming inflamed, ulcerative, 
necrotic, and ichrous. The general condition is not affected in 
non-malignant new formations (fibroma, lipoma, papilloma, 
osteoma, etc.). Malignant tumors on the other hand, espec- 
ially carcinomata, in addition to metastatic formation 
result in a general derangement of the nutrition ; this is char- 
acterized by emaciation, anaemia, hydraemia (cancerous 
cachexia), in which important nourishment is removed 
from the body on the one side, and toxic materials are taken 
up by the blood on the other (auto-intoxication). As 


DIAGNOSIS 103 


a result of ulceration of their surfaces many growths are 
hemorrhagic: chronic epistaxis in ulcerative angioma, 
adenofibroma, and carcinoma of the nasal septum of the horse ; 
chronic hematuria in carcinoma of the bladder in dogs. 
Finally tumors may cause secondary derangements of 
neighboring organs by compression (melanoma of the parotid 
region, of the rectum, on the tail; tumors in the air passages, 
in the brain, in the spinal marrow, in the vicinity of large 
vessels). 

DiaGnosis.—The diagnosis of a tumor as 
such, that is, differentiation from other swollen conditions, 
especially inflammatory, is not difhcult. Tumors usually 
meverop slowly and without. inflammatory 
map Lvoms (pain, increased heat). He ma- 
tomata are differentiated from new formations by their 
rapid, sudden formation. In contrast toa phlegmon or 
abscess, inflammatory symptoms usually fail in the devel- 
opment of tumors, this is especially true of pain and in- 
creased heat. Only chronic hyperplastic inflammatory pro- 
cesses are able, under certain conditions, to simulate tumor 
formation to such a degree that diagnosis becomes extremely 
dificult. Examples of this are seen in the wart-like forma- 
tions which follow dermatitis chronica on the flexor surface of 
the fetlock (dermatitis verrucosa), in the formation of exos- 
toses after periostitis, as well as in keloids in a cicatrix. 

DIFFERENTIAL DIAGNosIS.—The differential diag- 
nosis of individtiial tumors is more difficult. A 
classification of tumors can seldom be made on their macro- 
scopic appearance; a microscopic examination is more 
valuable for making the special diagnosis. For making a 
purely clinical macroscopic examination the following points 
are of value: 

1. The seat of the tumor with reference to the nature 
of the tissue involved is often an index to its character. 
According to experience, the penis, the testicles, and the 
mammae are frequently seats for the development of carcino- 
ma, sarcoma, and adenoma; the periosteum for osteoma and 
sarcoma ; the spermatic cord for botryomycoma ; the skin for 


104 DIFFERENTIAL DIAGNOSIS 


fibroma, carcinoma, and papilloma; the subcutem for lipoma 
and fibroma; the nasal cavities for myxofibroma and adeno- 
fibroma; the maxillary and frontal sinuses for sarcoma a0 
carcinoma; the nerves for neuroma. 

2. Occasionally the size and development. of the 
tumor is an index for its diagnosis. The malignant tumors 
are usually larger and develop more-rapidly than the non- 
malignant. Sarcoma and botryomycoma in the horse some- 
times develop very rapidly and attain an immense size. In 
the horse many sarcymata of the eye have a formidable devel- 
opment. Soft fibromata are characterized by a relatively rapid 
growth. Occasionally it is important to note whether the 
tumor is single or developing in several places. Papilloma 
and fibroma have a tendency to the production of multiple new 
formations (papillomatosis, fibromatosis), this is also true of 
botryomycoma. Sarcoma, carcinoma, and actinomycoma are 
multiple when metastatic formation results in gen- 
eralization (sarcomatosis, carcinomatosis). 

3. The surface of the tumor is rough in papilloma, 
botryomycoma, and carcinoma; lobulatedin lipoma ; compara- 
tively smooth in many sarcomata and fibromata. 

4. The consistency is softest in round-celled sar- 
comata, soft fibromata, lipomata, and myxomata, as well as in 
many cysts ; carcinomata and hard fibromata are more firm ; en- 
chrondromata and osteomata areas hard as cartilage and bone. 

5. Lhe relation of the tumor to titegeueum 


ortothe neighboring tissues, is of great diagnostic 


importance in malignant new formations (sarcoma, carcinoma) 
as they have a strong tendency to include the surrounding 
tissues in their. processes of degeneration. They are, there- 
fore, less sharply defined than the non-malignant tumors 
(fibroma, lipoma, papilloma) ; carcinomata frequently present 
superficial ulceration. Carcinomata and sarcomata frequently 
attack deeper underlying tissues, even involving the bone. 

6. Under certain conditions the race may be of im- 
portance. In cattle actinomycotic and tubercular new forma- 
tions are common; in horses, botryomycomata ; in dogs, car- 


Se 


STATISTICS 105 


cinomata. Grey horses are frequently affected with 
melanosarcoma. 

7. In doubtful cases age may be of importance in the 
diagnosis of cancer; young animals are seldom affected with 
cancer, on the other hand, they are frequent sufferers from 
sarcoma, lipoma, and papilloma. 

meee ine Of! tiversnerehn borin eae: lymph 
glands is characteristic of malignant new formations, this 
is especially true of cancer and sarcoma (metastasis). 


STATISTICS.—With the assistance of the statistical publications of 
Johneand myself,as well as the clinical annuals of the veterinary schools 
at Berlin, Munich, and Dresden, Casper has arranged statistics on 
tumorsin the domestic animals from various points of view (Pathologie 
der Geschwilste bei Tieren. 1899). Among 86,000 diseased horses, 1131 
(1.3 per cent) were affected with tumors; among 85,000 dogs, 4029 (4.7 
per cent) were similarly affected; among 5,000 cattle, 102 (2 per cent) 
were affected with new formations. In the years 1886-1894, I operated 
on 643 new formations in dogs. Of these, 262 (40 per cent) were 
carcinomata and adenomata; 97 (13 percent) fibromata; 
65 (10 percent) papillomata; 44 (7 percent) sarcomata; 39 (6 
per cent) lipomata; 2 (0.3 percent) angiomata. In the years 
1895-1902, I operated on 200 cases of new formations in the horse; 25 
percent of these were sarcomata, 20percent botryomycomata 
and fibromata, andiopercent were carcinomata. Therefore, 
sarcoma, botryomycoma, fibroma, and carcinoma are 
the most frequent tumorsin the horse. These four kinds 
of tumors form three-fourths of all new formations in the horse. They 


‘are. more frequent than cicatricial keloids, keratomata and 


papillomata. The following are the least common: lipoma, 
genuine osteoma, atheroma, adenofibroma and myxo- 
maof the nasal mucous membranes. The statistics of the 
Pathological Institute (Casper, Johne), which include new forma- 
tions of the internal organs that are not observed by the surgeon, 
afforded facts in accordance with clinical observations: that carcinoma 
is much more frequent in dogs than in horses or catttle ; and that in the 
two latter species sarcoma is more frequent than carcinoma. Among 123 
new formations in the horse, 60 were sarcomata (47 per cent), 28 car- 
cinomata (22 per cent); among 93 new formations in the dog, 48 were 
carcinomata (52 per cent), 26 sarcomata (28 per cent); among Io4 new 
formations in cattle, 36 were sarcomata (35 per cent), 28 angiomata (27 
per cent), 8 carcinomata (8 per cent). With reference to the topo- 
graphical distribution of tumors the following observations 


were made: carcinomata were most often found in the kidneys, 


106 TREATMENT 


the mammae, the maxillary sinuses, the thyroid glands, the skin, the 
lymph glands, and the testicles; sarcomata were most often found 
in the lungs, the liver, the lymph glands, the thyroid gland, the mammae 
and the kidneys. Compare with statistics on carcinoma. 

TREATMENT OF TuMORS.—In many cases, especially in non-malig- 
nant forms, treatment is superfluous (blemish). When treatment is 
indicated they should be operated at the earliest possible moment. 
Operation consists in removal with the knife, scissors, or curet. Early 
operation is especially indicated in sarcoma, carcinoma, and botryomy- 
coma (fistula of the spermatic cord). When an operation is followed by 
a recurrence of the tumor it indicates that small pieces of the tumor 
remained. Pedunculated new formations, as well as tumors in the body 
cavity (polypi of the nose, vagina, and rectum) may be removed by 
tearing and twisting, by means of a ligature (ligation of the 
neck of atumor), or with the ecraseur. The galvanocautery loop, 
employed in human surgery, is too complicated for veterinary use. In 
many cases the firing iron is indicated, especially the thermo- 
cautery, this acts as a hemostat during the operation, healing follows 
under an eschar which takes the place of a bandage. The earlier ex- 
tensively employed drugs should only be used in those cases where 
an operation is impossible, or for econimic reasons is not practical (for- 
maldehyde in many cases of cancer of the hoof). The recent treatment 
of certain tumors with iedid of potash is of some importance. It 
is a specific for goitre, as well as actinomycosis of cattle (not, however, 
against botryomycosisof horses). Iodid of potash may either be admin- 
istered internally, or applied externally in the form of Lugol’ssolution ; 
tincture of iodine is active when applied externally or by means of in-— 
jections. The internal administration of arsenic has a similar influence 
on papillomata. The parenchymatous injection of other remedies. 
(alcohol, acetic acid ) is of doubtful efficacy, the same is true of treatment 
with the aneline dyes; the same may also be said of the artificial pro- 
duction of erysipelas for the relief of carcinoma, a few examples of 
which have been followed by success in human medicine. Concerning 
the importance of the serum therapy compare with the chapteron 
‘“‘carcinoma.’’ Finally, the recently employed artificial inocculation of 
malaria is of very questionable value. 


SPECIAL KINDS OF TUMORS 107 


II. SPECIAL KINDS OF TUMORS. 
A. CONNECTIVE-TISSUE NEW FORM ATIONS. 


I. FIBROMA. 


Forms.—A fibroma or fibroid (connective-tissue 
tumor) is a desmoid tumor composed largely of connective 
tissue. Two forms are recognized: 1. Hard fibroma 
(fibroma durum, desmoid) is characterized by a hard, firm 
consistency ; when cut it presents a white, tendinous, glistening 
surface ; microscopic examination shows it to be composed 
principally of straight, stratified, or crossed connective-tissue 
fibers with a very few cells. 

2. Soft fibroma (fibroma molluscum) is less common ; 
it is soft in consistency ; when cut it presents a light-grey 
transparent surface; under the microscope it is seen to be 
composed of loose moist connective tissue with very many 
connective-tissue cells. Between the soft and the hard fibro- 
mata there are many transitional forms. Onealso differentiates 
circumscribed and diffuse, simple (solitary) and 
multiple fibromata (fibromatosis). Pedunculated fibromata 
on the mucous membranes are termed polypi (fibroma 
pedunculum) ; similar fibrous new formations on the skin and 
subcutem are termed cutis pendula (see below). Fibrous 
proliferations in cicatricial tissue are termed keloids. My- 
cofibroma isa Special infectious form due to the activity of 
the botryomyces fungus (botryomycoma). Finally, mixed 
tumors with other new formations are very frequent, for 
example, fibrosarcoma, fibrolipoma, fibromyxo- 
ma, tibroneuroma, fibroadenoma. 

With reference to the causes of fibromata nothing 
definiteis known. Recently it has been attempted to associate 
their development with traumatic and inflammatory influences. 
Their relation to inflammatory cicatricial tissue, especially 
the cicatricial keloids, as well as to the inflammatory connec- 
tive-tissue hyperplasias (elephantiasis, tumor fibrous) has been 
considered. At the most, repeated injuries or chronic inflam- 


108 OCCURRENCE 


mations are only occasionally the cause of fibroma formation. 
The principal cause, for the want of better knowledge, seems 
to lie in a fibromatous predisposition. ‘This explains the cases 
of congenital fibroma (congenital anlage of fibromata). The 
multiplicity of cutaneous fibromata in dogs and horses also 
speaks for the presence of an internal predisposing cause. 

OCCURRENCE.—Fibromata are benign, develop 
slowly, are usually roundish, circumscribed, 
nodular, smooth on the surface, firme 
hemorrhagic painlessnew formations of auni- 
form consistency. They are very common in the domestic 
animals and may develop in any organ that contains connective 
tissue. Their favorite seats, therefore, are in the sub- 
cutem, the submucosa, the periosteum, and the subfascial and 
intermuscular connective tissue; they are alsocommon in the 
uterus and in the nerves (so-called neuromata are nothing more 
jhan fibromata of the nerves). The following forms are 
of surgical importance in the domestic animals : 

1. Fibromata of the skin and subcutem are most 
frequently observed in horses and dogs. In the horse they 
are especially frequent on the head, shoulder, and region of 
the withers, as well as inthe sheath. Ordinarily they are soli- 
tary, sharply circumscribed, from the size of a pea to that of a 
fist. Occasionally they are multiple, as many as one hundred 
have been seen on a single horse (Siedamgrotzky). 
Subcutaneous fibromata average about the size of a goose-egg ; 
sometimes they lie in a capsule from which they may be re- 
moved after a skin incision has been made (Moller). In 
rare cases fibromata are found in the shoulder region in the 
form of so-called shoulder abscesses (personal observations). 
Bayer has observed fibromata on the scrotum of a horse that 
were multiple, soft, and recurrent after removal. ‘ Many fibro- 
mata of the horse are not genuine fibromata, but mycofibro- 
mata (compare with the chapter on botryomycoma). Many 
inflammatory connective-tissue hyperplasias are erroneously 
termed fibromata ; to this class belong those found in harness 
positions in horses and cattle (see below). According to my 
own experience cutaneous fibromata are very common in dogs. 
They are often multiple, especially on the thorax, on the ex- 


OCCURRENCE 109 


tremities, on the ears and eyes, on the back, on the tail, and 
in the mammae. Asin horses, hard fibromata are most com- 
mon; the soft form are seldom found. ‘Their size is variable ; 
as a rule they are small, sharply circumscribed, hard, smooth, 
and intact on the surface. Pendulous fibromata are occasion- 
ally observed. In cattle myxomatous fibromata are occasion- 
ally seenon thetail( Mayr). Peter has described a fibroma 
on the head of a cow; the tumor weighed 11% kg., was pen- 
dulant, and combined with cutaneous horn. On the other 
hand, the subcutaneous, calcified, new formations of fibrous” 
tissue in the vicinity of dead larvae are not genuine fibromata 
(hypodermoliths of Caparini). 

2. Fibromataofthe mucous membranes areeither 
flat, circumscribed proliferations with a broad base, or pedun- 
culated tumors (polypi, polypoid fibroma) ; their 
consistency is soft. Not all polypi of the mucous membranes 
described in the literature are genuine fibromata. Many other 
tumors of the mucous membrane have a pedunculated form ; 
for example, lipoma, actinomycoma, and sarcoma. According 
to the seat, one speaks of nasal, pharyngeal, laryngeal, vagi- 
nal, cystic and rectal polypi. 

In the nasal cavities the flat and polypoid fibromata 
(myxofibroma) of the nasal mucous membranes are of 
special importance in the horse ; this is due to the fact that so- 
called nasal polypi produce a stenosis of the nasal pas- 
sages, causing dyspnoea, chronic unilateral nasal catarrh, and 
in ulcerative degeneration, an ichorous, fetid nasal discharge 
with unilateral swelling of the glands (suspected glanders). 

In the uterus and vagina of the horse, cow, dog, 
and pig, pure fibromata and mixed tumors (fibromyoma, 
fibromyxoma, fibrolipoma) occur in various forms. 

Fibromata of the vagina are frequently pedunculated 
(vaginal polypi). Typical fibromata from the size of a 
cherry to that of a walnut are found in the vagina of the dog. 
These vaginal polypi have a firm, hard consistence, occasion- 
ally they are long and bottle-shaped ; they present no inflam- 
matory symptoms. They are readily differentiated from those 
chronic inflammatory swellings of the mucous membranes 
which also develop in the form of pedunculated new forma- 


IIo TREATMENT 


tions (so-called plicae polyposae). Fibromyomata in the uterus 
of cattle and swine sometimes reach an enormous size (50 to 
200 pounds). In such cases the uterus extends into the abdomi- 
nal cavity. ‘Tumors which extend through the os uteri into 
the vagina are smaller. Polypoid fibromata may also develop 
inthe pharynx or larynx (the so-called laryngeal polypi 
in cattle are usually of an actinomycotic nature), in the gut- 
tural pouches, in the bronchi (polypi which follow 
tracheotomy in the horse are usually granulomata or botryo- 
mycomata), in the rectum, bladder, urethtageame 
teat canals. 

3. According to Kitt, fibromata of the udder are 
characterized by hard, nodular, sharply circumscribed swell- 
ings; in the dog they are from the size of a dove’s egg to that 
of a man’s fist. They are composed of a mucoid and gelatin- 
ous substance (myxofibroma). Occasionally, in addi- 
tion to proliferation of the connective tissue, the glandular 
tissue also proliferates (adenofibroma). Similar fibro- 
mata are found in the testicles of dogs and horses. 

4. Inthe internal organs fibromata are seldom ot 
surgical importance. Kitt has observed a fibroma on the 
tongue of acow; it was hard asa board, sausage-shaped, 
-16 centimeters long and 10 centimeters wide. Juredieu 
has described a fibroma of the pelvis of adog; it was as 
large as a hen’s egg. It is not known whether fibromata 
develop in the vertebral column of the domestic animals, thus 
causing paralysis from pressure on the spine (lumbar 
paralysis), similar to lipoma, sarcoma, and other new 
formations. They are found, however, in the form of osteo- 
fibromata in other osseous cavities, forexample,the tym- 
panic cavity of the horse (Fretjanow). 

TREATMENT.—Treatment of fibroma consists in operative 
removal by means of the knife, scissors, ligature, etc. Large 
fibromata are extirpated with the scalpel and the wound 
sutured ; small tumors may be removed in the same manner. 
In the latter, healing may be produced under an eschar by 
means of cauterization. Very large, diffuse fibromata, which 
cannot be entirely removed at one time may be operated on at 
different times ; repeated partial operations until the enlarge- 


KELOID III 


ment isentirely removed. Operations upon polypoid 
fibromata are very difficult. When one can reach 
them with the hand (vagina, rectum) they may be ligated ; 
ligation is more reliable when a double suture is passed through 
the neck of the polypus and tied on both sides. Polypi that 
cannot be so easily reached may be removed with the ecra- 
seur, this applies especially to nasal polypi. In many cases 


they must bet orn or twisted away with the handor forceps. 

KELoIp.—A keloid is a tumor-like, fibrous, hard proliferation of 
the skinand subcutem ; it usually develops from cicatricial tissue ( cica- 
tricial keloid). Incontrasttothis,a spontaneous (genuine) 
keloid has been differentiated. According to recent investigations the 
existence of a “‘spontaneous’’ keloid is questionable ; this is due to the 
fact that experience has demonstrated that keloids usually develop after 
traumatic or inflammatory processes in the skin. The causes of keloid 
formationare not yet fully understood. Some maintain that itsdevelop- 
ment depends ona specific infection of the wound, they claim 
that this accounts for its recurrence following operations; according to 
others, the existence of keloids depends on an individual fibroma- 
tous disposition of the body. In the domestic animals keloids 
are most often met with in the horse. They follow injuries to the 
coronet, the balls of the heel, the‘flexor surface of the 
peELOcE joint, the flexor surface of the tarsal joint, as 
well as to the region of the tendons; occasionally they develop 
after gangrenous dermatitis (grease), after firing, and after the applica- 
tion of blisters. They form circumscribed, hard, fibroma-like new 
formations that are usually extensive in size ; they are relatively rich in 
blood-vessels ; in contrast to normal cicatricial tissue, they are covered 
with a thick layer of epidermis. To a certain degree they are a highly 
developed form of the so-called hypertrophic cicatrix (see page 22). 
According to my own observations the continual movement and irrita- 
tion of a wound that is often very insignificant appears to be one of the 
principal factors on which keloid formation depends. I have never 
observed recurrence following operations. According to Labat, 
Leblanc, and others, on the other hand, many keloids are recurrent 
after excision; they caution, therefore, against the operation, and em- 
ploy the elastic ligature (?) in combination with a disinfectant bandage 
applied daily. Johne hasdescribed a cicatricial keloid of the flexor 
tendons of ahorse; this wasin the form of a hard, tendinous oval 
tumor, 27 centimeters long and 18 centimeters wide, it was fungus-like, 
proliferated from the tendon cicatrix, and adhered to the tendon-sheath 
and skin. I have observed many similar forms of tendinous keloids on 
the extensor tendons of the coronet following treads on the coronet. 


112 ELEPHANTIASIS 


ELEPHANTIASIS.—The name elephantiasis, (schleroderma, 
schlerosis, pachyderma) indicates a connective-tissue hyper. 
plasia of the skin and subcutem, which results in a pro- 
nounced thickening of those parts of the body involved. It is very rare 
that elephantiasis is caused by a genuine fibroma; in such cases it 
assumes the form of a diffuse fibromatosis. In the horse it is 
usually the product of chronic inflammation of the skin or 
subcutem (chronic indurative dermatitis and phlegmon following 
scratches and phlegmon: so-called thick leg, elephant leg) ; or 
specific, chronic inflammatory processes in the vicinity of the lymph- 
vessels (glanders). Elephantiasis may also be caused by chronic 
edema in the vicinity of the veins, as well congenital 
dilitation of the lymph-vessels. In man the principal causes 
of elephantiasis are leprosy and filaria sanguinis; according 
to the condition of the skin the following forms are recognized: ele- 
phantiasis glabra, verrucosa, ulcerosa, papillaris. Occasionally there 
seems to be an individual predisposition to fibrous hyperplasias (ele- 
phantiasis). Labat observed this in a horse on which a blister 
(potassium bichromate) had been applied after firing; this was followed 
by an extensive (60-70 centimeters large) fibrous new formation on the 
limbs. Similar observations have been made by Rabe and Lustig. 

TyvLomMa.—Tylomata are fibrous dermal prolifera- 
tions (continual pressurefromthe saddle) that develop 
from the subcutaneous tissue; they are the result ofa 
chronic, hyperplastic inflammation. They belong, similar 
to elephantiasis, not to the genuine new formations, but are to be con- 
sidered as chronic, inflammatory, connective-tissue hyperplasias. In 
contrast to the circumscribed fibromata they are diffuse hard thicken- 
ings of the skin and subcutem, they are found at the seat of the collar 
in horses, on the carpus in cattle, on the elbow and ischial tuberosity in 
dogs. They are sometimes so heavy as to cause a suspension of the 
fibrous thickenings of the skin (cutis pendula). Occasionally they are 
circumscribed, when it is very difficult to differentiate between them 
and genuine fibromata. Callosities of the skin, in contrast to 
tylomata, consist of a hypertrophy of the epidermis, there is always 
present, however, a chronic, connective-tissue hyperplasia of the cutis. 

RHINOSCHLEROMA.—According to Hebra (1870) rhinoschle- 
roma in man isa specifictumor-like disease characterized by the forma- 
tion of hard nodules in the skin and mucous membranes of 
the nose, they afterwards extend to the lips, the superior 
maxillae, the nasal cavities, the pharynx, etc. Thecourse 
is chronic and incurable, it occurs only in certain environments 
and countries (Southern Russia, Eastern Provinces of Austria, Central 
and South America). The principal symptoms consist of cartilaginous, 
painful thickenings of the nose which extend into the deeper tissues, 


LIPOMA 113 


as well as on the surface ; ulcerative degeneration sets in, and they are 
finally transformed into connective-tissue folds. This resultsin stenosis 
and deformity of the nose, mouth, gums, and pharynx. 
The rhinoschleroma bacilli have been discovered as the cause 
of this peculiar affection; they are found in the large, swollen, non- 
nucleated cells of the diseased tissues. Transmission of this 
bacillus to other animals has not been followed by 
results. 

In veterinary literature various affections of the horse have 
been described under the name rhinoschleroma (Grawitz, Dieck- 
erhoff, Rabe, Schulz and others); in many essential points 
they are different from the disease described under that heading in 
man. In the horse it is manifestly an entirely different affection. 
Moller and Johne also maintain that this is an incorrect term for 
nasal tumors in the horse. According to Kitt the process is an 
adenofibrous hyperplasia of the nasal mucous mem- 
branes (adenofibroma). Under the microscope one finds 
fibrous hyperplasia and amyloid induration of the connec- 
tive tissue, pronounced proliferation of the mucous glands, as 
well as new formation, and dilitation of the vessels. Because of the 
rich blood-supply it may be easily confused with angioma. The new- 
formations consist of hard, nodular, lobulated, smooth, flat, lar- 
daceous, transparent proliferations located close together ; ordinarily 
they arefoundonly inthe lower third ofthe nasal cavity (pavement 
epithelium) ; they are usually bilateral, andare hemorrhagic on the 
surface (epistaxis). Ulceration, dried blood, and cicatricial formation 
may be present (confusion with glanders). I have operated 
several cases in the horse with good results. 


Fry LIPOMA. 


Forms.—Lipomata or fatty tumors are composed 
principally of fat-cells which lie in a framework of connective 
tissue. In structure they are similar to normal fatty tissue, 
_ they may occur in any part of the body where that tissue is 
present, especially when it exists with connective tissue. They 
are usually located, therefore,,in the subcutaneous, submucous, 
subserous, subsynovial, and intermuscular connective tissue. 
If the fat-cells are in excess it is termed a soft lipoma; 
when more connective tissue is present it has a firm consistence 
(hard lipoma). Occasionally lipomata are pedunculated 
(lipoma pendulans, lipoma polyposum). Lipoma 
aborescens isa special form that develops in the vicinity 


114 LIPOMA 


of joint-capsules, after rupture of the capsule the lipoma pro- 
liferates in the form of a tree-like growth. Like fibromata, 
mixed forms arecommon: lipofibroma (lipoma fibroma- 
tosum, steatoma), lipomyxoma (lipoma myxomatosum). 

OcCURRENCE.—Lipomata are not common. They form 
circumscribed, roundish or oval tumors; occa- 
sionally they are pedunculated and therefore 
pendulant; some are small, others att aie 
enormous size; they.are nodular, lobulated, 
and occasionally very soft; they crepitatemum 
peculiar manner, apparently fluctuate onypeee 
pation, and develop very rapidly. OtWen moma 
are hard, develop slowly, are usually solitary, 
but are sometimes multiple. They are non- 
malignant tumors and never spread by metas- 
tasis. Itisa peculiar fact that they are not confined merely 
to well-nourished animals, but often accompany anemic condi- 
tions; when the animal is affected with general emaciation 
their size does not decrease. They may undergo caseous de- 
generation. When injured, suppuration may occur ; occasion- 
ally they are congenital. 

Of those lipomata which occur in domestic animals the 
following are of importance : 

I. Subcutaneous lipomata are especially common in 
horses and dogs. In the horse they occur on the sheath, tail, 
and anus (Bayer), also on the walls of the thorax and 
abdomen, and on the posterior limbs ; they are often multiple. 
The vicinity of the biceps and knee-joint seems to be 
a favorite seat for their congenital appearance in foals (per- 
sonal observations) ; in this case they are circumscribed and 
develop very rapidly. Moller observed a lipoma in the 
vicinity of the lower end of the biceps femoris that weighed 
25.5 kilograms, Rhode observed one about the size of two 
fists just above the patella on the external surface. In dogs, 
where lipomata occur principally on the inner surfaces of the 
limbs, on the thorax, and on the shoulder, I have observed 
twelve cases. Their form is round or cylindrical, the size is 
extremely variable, occasionally attaining that of a man’s 


LIPOMA 115 


head. They develop slowly, have a lardaceous consistency, 
lobulated structure, and many times a pedunculated form 
(pendulant). One also occasionally observes wandering lipo- 
mata. 

2. Pedunculated Lipomata and lipofibromata are some- 
times found on the mucous membranes of the horse in 
the upper portions of the nasal cavities; they originate 
from the nasal septum, the turbinated bones, or the ethmoid 
bone (Gurlt). Occasionally they develop inthe larynx; . 
Fricker has described a case of lipoma on the anterior sur- 
face of the epiglottis in a horse (laryngeal polypus), 
the tumor was as large asa potato. Submucouslipomata in the 
rectum cause obstruction and colic (Brose, Lessa). 
Vaginal polypi are occasionally found in the mareon the vaginal 
floor. Polypiare also found onthe membrana nictatans 
in dogs (personal observations). 

3. Subperitoneal lipomata of the abdominal 
cavity are relatively frequent in the horse; they constrict 
the small intestines or rectum and lead to fatal colic. The 
new-formations have a long neck, are pendulant, and originate 
from the omental attachment; they possess no surgical im- 
portance. Werner, in cattle, has diagnosed a lipoma per 
rectum; the tumor was the cause of colic, and removal 
through the flank resulted in‘a satisfactory termination. On 
rectal exploration of a horse suffering from colic Sommer 
recognized the presence of a tumor anterior to the bladder ; 
on post mortem this proved to be a lipoma. 

4. Lipomata are seldom found in other organs. 
Occasionally they develop from the dura; at other times 
from the pia (Kiihnaeu). Pfister published the records 
of a case wherea lipoma was found to be the cause of lumbar 
paralysis inacow; the tumor was located in the lumbar 
region of the vertebral column. Ebinger has described a 
similar case. According to Stockfleth they are occasion- 
ally found in the udders of fat bitches. Esser removed a 
lipoma that weighed four kilograms from the left half of the 
udder of a mare. According to Montfallet lipomata in 
the udder of the bitch are usually perimammary, seldom inter- 
glandular. 


116 MYXOMA 


Treatment of lipomata consists in extirpation with 
the knife; pendulant lipomata may be removed by means of a 
ligature. 


III. MYXOMA. 


DEFINITION AND OCCURRENCE.—M yxomata (mucous 
tumors) are composed of a gelatinous mucous tissue, with 
stellate, branched, connective-tissue cells, an abundance of 
mucous substance is also interposed. Their independent exist- 
ence as tumors is disputed. Apparently they are 
nothing more than edematous fibroOmapamae 
lipomata (Koster). The soft, edematous, gelatinous, 
swollen lipomata and fibromata are better termed my xofi- 
bromata and myxolipomata. Other mixed formsare: 
myxomyomata, myxochondromata, fibrosarcomata, and other 
muco-edematous forms. Myxomata, like fibromata and lipo- 
mata, arenon-malignant tumors; they develop in the subcutis, 
submucosa, subserosa, on the periosteum as well as beneath the 
fascize. Occasionally they become sarcomatous. 

Myxomata and myxofibromata appear, relatively, to be most 
frequent in the nasal cavities of the horse, where they 
result in the formation of so-called nasal polypi (Mol- 
ler, Hamburger, personal observations). Pedunculated 
myxofibromata are also observed on the floor of the rectum in 
the horse, they areintheform of bean-shaped rectal polypi 
the size of a child’s head (personal observations.) According 
to Kitt myxomata occur in cattle in the sinuses of the 
head where they may become three times the size of a man’s 
fist ; they are smooth, nodular or lobulated, and are composed 
of glassy, swollen, mucous vesicles containing masses of connec- 
tive tissue. Myxomata have also been seen in the sinuses of 
the headin sheep (Cagny); and inthe bladderin cattle 
(Leisering). Myxomyomata, myxofibromata, and fibromyx- 
osarcomata have been observed in cattle in the uterus (Kitt ); 
in the mamme of mares and bitches (Kitt, M’Fadyean); 
in the subcutisof the horse (Ehlers) ; inthe cutisof calves 
in the form of soft tumors the size of hens’ eggs on the inferior 


oF See 


CHONDROMA T17 


surface of theabdomen (Molier); aswell as beneath the dura 
of the spinal marrow thus causing spinal paralysis ( Brats- 
chikow, Holzmann). Finally, myxoma has been 
observed in the placenta (De Bruin). 

Treatment of myxomata of the nasal mucous membranes 
consists in tearing out, and twisting off, as well as extirpation 
after previous trepanation of the nasal cavities. 


Mucous DEGENERATIONS OF THE TURBINATED BONES.—Under 
thisheading Sand (Monatshefte fur Tierheilkunde. 1893) has described 
a tumor-like swelling of the facial bones of foals; it was charac- 
terized by dyspnea and nasal discharge, as well as mucous softening of 
the turbinated bones, and the osseous walls of the superior maxillary 
and frontal sinuses. The latter become dilated, and are affected with 
hydrops and empyema. I have observed similar cases. 

Mvx8DEMA.—The following symptoms have been observed follow- 
ing disease or removal of the thyroid gland in man: edematous swell- 
ings of the skin of the face and extremities (collections of mucin), 
with pronounced general decrease in nourishment, strength, and psychic 
activity (cachexia strumapriva following thyroid operations; related to 
cretinism). Recently myxedema has been successfully treated in man 
by the administration of thyroid-gland substance and thyroid-gland 
preparations (iodothyrin). The existence of myxedema is explained as 
follows: it is the function of the thyroid gland to prevent the formation 
of mucin in the body; in myxedema this function is destroyed (?). 


IV. CHONDROMA. 


NATURE AND OCCURRENCE.—Chondroma (enchon- 
droma, ecchondrosis, cartilaginous tumors) is a name applied 
to tumors composed largely of cartilage; this form of new- 
formation is apparently rare. Hyaline cartilage is the principal 
component (large or small cells). They are found in the fol- 
lowing places: 

a) in cartilage (ecchondrosis or hyperplastic chon- 
droma) ; 

b) in bones, on the ribs, in the pelvis, on the vertebral 
column, on the first phalanx, on the ethmoid bone, and sphenoid 
bone ; 

¢c) inthe udder, testicles, thyroid gland, in 
the parotid, in the subcutem, and in other organs 
that are normally free from cartilage (enchondroma in the nar- 


118 CHONDROMA 


row sense; heteroplastic chondroma). ‘The occurrence of 
chondromata in these organs is partly due to a metaplasia 
(metamorphosis) of connective-tissue cells and endothelial cells. 
into cartilage cells, partly to aberration of germinal cartilage. 

Chondromataare benign tumors, they areusually 
solitary but occasionally multiple; tie yee 
spherical in form (udder), and occasiomagie 
very large... They are nodular, elasticjgiimgs 
and painless. Chondromata are usually observed in com- 
bination with other tumors (chondrofibroma, osteo- 
chondroma, chondrosarcoma); they may undergo 
softening, cystic degeneration, calcification and ossification. 
An osteochondroma is composed of material similar to. 
non-calcareous (osteoid) bone tissue. 

In the domestic animals chondromata are most often found 
inthe mamme of the bitch; they are from the size of a pea to 
that of a man’s fist, round, firm, painless, and sharply cirecum- 
scribed from the normal glandular tissue; they are nodular 
and are not adherent to the skin. Cartilaginous, nodular, 
sharply circumscribed chondromata are repeatedly found in the 
testicles of the horse (Kitt). They arevaismaae 
quently found on the costal cartilages of the horseand 
ox; in this case they may possibly have a traumatic origin 
(Bruckmuller, Kitt, Hahn, personal observations). 
Chondromata are found in the vicinity of the thyroid 
gland (Siedamgrotzky, Zahn). Sé€id@anupeeae 
tzky described a chondroma that was twice as large as a 
man’s fist, it was located on the first phalanx of acow. They 
have also been found on the maxillae and in the nasal 
cavities of horses and dogs (Gurlt, Kitt); on the verte- 
bral column of a dog with spinal paralysis (Smith); in 
the vicinity of the earincattle; at the baseof the second and 
third cervical vertebre, hard tumors weighing 4% kilograms 
and as large asa man’s head (Morot); in the subcutis of 
cattle, horses, anddogs (Janson, Morot, Leisering, 


Ostapenko); on the vocal cord of ahorse (Lee); as 


well as in the crystalline lens of a foal (Renner). 
Treatment consists in extirpation ; when large chon- 


OSTROMA 119 


dromata are present in the udder it should be amputated. In 
my experience many cases of chondroma of the udder in dogs 
do not require treatment ; this is due to their stability and 
non-malignant character. 


V. OSTHOMA. 


NATURE AND OCCURRENCE.—An osteoma or bone 
tumor is composed largely of osseous material. It is analo- 
gous tochondroma. With reference to their occurrence they 
may be arranged as follows: 

a) Those occurring in bone (hyperplastic osteoma) ; 
they develop partly from the periosteum, partly from the tela 
ossea, and partly from the bone-marrow. ‘They are known by 
various terms: exostoses, osteophytes, hyperos- 
toses, enostoses. To this class also belong new for- 
mations of bone due to inflammation (exostoses). 

b) Osteoma may also occur in the following organs, 
although they contain no bone-cells: the mammae, 
parotid, brain, muscles, and other organs that nor- 
mally contain no bone-cells (heteroplastic osteoma) ; they are 
either due to metaplasia, or aberration of embryonic tissue. 

According to the consistency one speaks of an osteoma 
durum or eburneum (hard as ivory), spongiosum 
(spongy), and medullare (composed largely of marrow). 
According to the covering it is termed a cartilaginous 
exostosis (covered with cartilage), ora bursal (located 
beneath a mucous bursa). Mixed forms of osteomata are also 
frequent: osteosarcoma, osteofibroma, and osteo- 
chondroma. Osteomata with broken attachments so that 
they lie free in the cavities of the head are termed dead osteo- 
mata. Unattached osteomata are located in tendons and 
muscles away from the bone. 

Osteomata form very hard, bone-like, painless, 
benign tumors; they are more or less sharply 
Pemeiimeoctribed, partly. multiple, partly.sel- 
Stewed d are usually located beneath the 
skin. Inthe domestic animals they are more frequent than 


120 MYOMA 


chondromata. The following forms are of practical importance : 
osteomata that frequently occur on the inferior maxilla 
and metacarpus, and are usually due to an ossifying 
periostitis, occasionally, however, they are genuine tumors 
(pedunculated fungoid and knob-like osteomata on the free 
margin of the inferior maxilla) ; osteomata of the udder and 
testicles in horses, cattle, and dogs; of thecrystallinelens . 
inthe horse ; as wellas those which occurinthe cavities of 
the head of both the horse andcow. ‘The latter apparently 
develop from rudimentary cartilaginous areas of the sphenoid 
and ethmoid bones and occasionally form so-called total osteo- 
mata (ossified brain). Odontomata and dental osteo- 
mata of the teeth, on the maxillz, and on the petrous por- 
tion of the temporal bone, are special forms. 

Treatment consists of removal by means of the saw, 
chisel, or trephine. . 


VI. .MYOMA, 


NATURE AND OCCURRENCE.—A myoma or muscle- 
tumor is composed of muscle-fibers. According to the 
character of the fibers they are classified as follows: 

(a) Leiomyomata (myoma levicellulare), the more com- 
mon form, are composed of non-striated muscle-fibers. They 
are usually found in .the stomach, intestines, uterus, in the 
bladder, as well as metaplastically in tumors of the kidneys, 
testicles, and ovaries; occasionally they are combined with 
other tumors (myofibroma). 

(b) Rhabdomyoma (myoma Striocellulare) is rare; 
it is composed of striated muscle-fibers, and is occasionally 
found in mixed forms (myosarcoma). 

Myomata are of slight Surgical importance as they are 
usually found only in the internal organs. , Kitt has de- 
scribed a subcutaneous leiomyoma of the crural muscle, it 
weighed 250 grams. Gratia has described a rhabdomyoma 
which had its seat on the vagus at about the middle of the 
cervical portion in the horse. Monod has operated an 
encapsuled rhabdomyonia as large as a goose-egg in the 


NEUROMA | I2I 


vicinity of the shoulder in the horse. Siedamyrotzky 
has observed a leiomyoma ofthe testicles; Kolesnikow 
observed a rhabdomyoma of the tail. Leiomyomata of the 
uterus are far more frequent (Kitt, Frank, Johne, 
Eber, Gratia, Harms); the same istrue of peduncu- 
lated leiomyomata of the vagina that cause sterility (De 
Bruin); leiomyomata that lead to stenosis of the intestines 
(Schutz, Tetzner, Cadeac) and stomach (Rabe, 
Lothes); as well asthose of the bladder (van Tright, 


Tienaux, Voirin, personal observations), and 
kidneys (Johne). With reference tothe treatment, myomata 
of the uterus are experimentally treated, as in the human 
family, with internal administration of ergot. 


VII. NEUROMA. 


NATURE AND OCCURRENCE.—Two varieties of new for- 
mations are described under the term neuroma, or nervous 
messiue tumors. © 

(a) Genuine neuromata are a new formation composed 
essentially of nerve-fibers ; they may be medullated (neuroma 
myelinicum), or non-medullated (neuroma amyelinicum). 
This form is very uncommon in man, and has not been ob- 
served in the domestic animals. 

b) False neuroma is a fibroma or myxoma of the 
nerves (neurofibroma, neuromyxoma). It develops from the 
connective tissue of the perineurium, and is composed princi- 
pally of connective tissue or mucous tissue. These neurofibro- 
mata in the horse occasionally develop asa result of neurec- 
tomy when the operation is followed by a neuritis, they also 
occur in saddle horses on the internal tibial nerve. Analogous 
to the amputation-neuromata in man, they form spindle- 
shaped or oval enlargements on the central end of 
the nerve; they are white in color, froma beantoa 
dove’s egg in size, and cause lameness. They 
have been seen on the median nerve (Moller, Trasbot 
and others, personal observations) ; on the volar and planter 
nerves ( Hardy, Brauel, Rey and others, personal obser- 


122 ANGIOMA 


vations); also on the peroneus (Bayer), and tibialis 
(Becker). That form of false neuroma recognized in man 
under the name helicine neuroma (plexiform neuroma) 
has been repeatedly observed in cattle (Morot, Ostertag, 
Tiemann, Matschke); it is multiple and develops in 
the form of nodules and cords. Its favorite seat seems to 
be in the brachial plexus, the cervical, thoracic, and abdomi- 
nal ganglize of the sympathetic, as well as on the intercostal 
nerves. In one case, multiple neurofibromata produced symp- 
toms of paralysisintheox (Matschke). Zietschmann 
described two other cases of multiple neuroma formation and 
chronic interstitial neuritis of the brachial plexus in cattle, 
there were no special symptoms of paralysis, the enormous 
anatomo-pathological changes were remarkable when contrasted 
with the clinical symptoms (slight motor weakness.) One case 
of helicine neuroma has also been observed in the horse 
Gietse ning). 

Gliomata area result of proliferation of the neuroglia 
cells (supporting cells) of the brain and spinal marrow, they 
are of no importance from a surgical standpoint. So-called 
glioma of the retina is a sarcoma (gliosarcoma). 

Treatment of neurofibromata consists of free exposure 
and extirpation, recurrence is possible and the neurectomy 
may have to be repeated. 


VIII. ANGIOMA. 


Forms.—Angiomata or vessel-tumors either 
originate from blood-vessels (hemangioma, angioma 
in the narrow sense), or from the lymph-vessels 
(lymphangioma). Angioma is a collective term for 
various tumors which are composed principally of dilated 
hypertrophic, abnormally twisted, and newly-formed vessels. 
The following forms are recognized : 

a) Angioma simplex (teleangiectasis, naevus, nevus 
vasculosis, birth-mark, fire-mark) is composed of dilated and 
newly-formed capillaries of the skin. 

b) Angioma cavernosum (tumor cavernosus) is 


ANGIOMA 123, 


a venous new-formation of the skin, mucous membranes. 
(nasal mucous membranes), bones, liver, etc. It is a cavern- 
ous-like body containing large spaces that communicate with 
one another. 

c) Angioma racemosum (helicine angioma) is char- 
acterized by its serpentine structure. 

d) Angioma lymphaticum (lymphangioma, lymph- 
angiectasis) is a rare form; it is composed of dilated and 
newly-formed lymph-vessels. It occurs in the skin (congeni- 
tal elephantiasis), the tongue (macroglossia), and the lips 
(macrocheilia). It develops in the form of an angioma sim- 
plex, cavernosum, and cysticum. 

e) Fungus vasculosus (fungus hematoides) is not a 
genuine angioma, it isa term that indicates various extremely 
hemorrhagic new-formations. 

OcCURRENCE.—In the domestic animals angiomata are 
observed in various parts of the body. The most important 
are the superficial angiomata in the form of edematous areas on 
the nasal mucous membranes of the horse, they 
are usually cavernous, seldom simple, and lead to epistaxis, 
ulcerative formations, dyspnea, and suspicion of glanders. 
Deigendesch described a case of angioma which for ten 
years caused periodicepistaxis. Lubkesaw acaseof cavernous 
angiomaofthe mucous membranes of the nose and 
eyes ina horse; there was hemorrhage from these organs 
that even extended tothe lachrymal duct. Schutz observed 
angiomatous ulcers on the nasal mucous membranes as large 
asa man’s hand. Finally, angiomata of the nasal mucous 
membranes are many times confused with other hemorrhagic 
new-formations, especially the adenofibrous hyperplasias in the 
same region (see page 113). 

According to Zschokke osteoangiomata at the base 
of the tail incattle are not uncommon. They form tumors 
twice the size of one’s fist, which grow entirely through the 
body of the vertebrze, are composed of numberless dilated 
blood-vessels, and are made up of a reticulated, spongy, bone 
substance. Rosenbaum observed a similar very hemorr- 
hagic new-formation on the tail of anox. Angiomata of the 


124 LYMPHOMA 


skin and subcutem arelesscommoninanimals (Bon- 
net, Leisering, Johne, Moller, Siedamgrotsky, 
personal observations). Grebe has observed a 
cavernous angioma as large as a fist on the gums and lips of a 
horse ; the animal died during operation. Zschokke has 
described an angioma at the base of the skull in a cow; it 
developed along the nerves which supply the external ocular 
muscle, causing its paralysis and strabismus convergens exter- 
nus. Francesco has described an angioma on the penis of 
a horse; it was the cause of frequent and severe hemorrhage. 

Leisering and Eggeling have seen angiomata of 
the vaginal mucous membranes in cows. Stenzel has in- 
vestigated four cases of angioma of the udder in cows. 
Schindelka has described a lymphangioma of the mamma 
inacat. Angiomata of the liver, which occur frequently 
in cattle and other animals, are of no surgical importance. 

TREATMENT.—Healing of angiomata of the nasal cavities 
in the horse cannot often be attained because of their deep 
situation. Superficial angiomata of the skin are occasionally 
very difficult to extirpate on account of their size and extent. 
In human surgery the following methods of therapy are em- 
ployed: Ligation of the blood-vessels which supply the part, 
cauterization, firing, puncture with the thermocautery, appli- 
cation of the galvanocautery, as well as the injection of liquor 
ferri chloridi, alcohol, tincture of iodine, and extractum 
secalis. 

IX. LYMPHOMA. 


NATURE.—Lymphoma (tumor of a lymph-gland) isa 
name used to indicate various disease processes of the lymph- 
glands. 

a) Leukemic lymphoma during. the course of 
leukemia. 

b) Malign lymphoma during the course of pseudo- 
leukemia. 

c) Lymphosarcoma, lymphadenoma, car- 
cinoma and other genuine new formations in the lymph- 
glands. 


SARCOMA 125 


iiplikiamimatony,  hyperplasiaicot-thie 
lymph-glands following chronic inflammatory processses 
of neighboring organs (catarrh, strangles, glanders, tuber- 
culosis, actinomycosis). 

The so-called malign lymphoma (progressive hyper- 
plasia of the lymph-glands, lymphadenia, lymphomatosis ma- 
ligna, Hodgkin’s disease, pseudo-leukemia) which frequently 
occurs in man, is also seen in cattle, horses, and dogs. Like 
leukemia, without however, a marked increase in the number 
of white blood-corpuscles in the blood, it is characterized by 
the enlargement of groupsof lymphatic glands, or enlargement 
of the entire lymphatic system of the body. They are arranged 
in the form of multiple, nodular or clump-like, 
lardaceous, soft or hard, painless, often very 
Penge tumors in ‘the vicinity of .the inter- 
maxillary glands, the superior, middle, and in- 
ferior cervical giands, the inguinal, knee, 
and pelvic glands. On account of the generalization 
of this disease surgical interference is of no use; treatment 
is confined to the internal administration of arsenic or iodid of 
potash. Solitary lymphomata in the intermaxillary space in 
the horse may be extirpated without difficulty. Operative re- 
moval for diagnostic purposes may be indicated (suspected 

glanders). 


X. SARCOMA. 


NATURE.—A sarcoma is a desmoid tumor which may be 
termed an atypical proliferation of the embryo- 
nic connective tissue. It is a malignant con- 
nective-tissue new-formation in which the 
cells (round-cells, spindle-cells, giant-cells, 
endothelial cells) are far in excess of the in- 
tercellular substance. They often develop very 
rapidly, when they are usually associated with metastatic for- 
mation through the medium of the veins. Sarcomata develop 
anywhere in the body where connective tissue is present. Their 


126 SARCOMA 


favorite points of development are the periosteum, the bone- 
marrow, the lymph-glands, the cutis, the subcutaneous, sub- 
mucous, and subserous (subperitoneal, subpleural) tissues, the 
eyes, the glandular tissues (testicles, mamma, thyroid), as well 
as the vessel-walls. Sarcomatous cellular activity is often 
followed by regressive conditions ; these are softenings, cystic 
formations, hemorrhage, ulceration, and suppuration. Asin 
other tumors, mixed forms arecommon ; forexample, fibro- 
sarcoma, chondrosarcoma, myxosarcoma, osteo- 
sarcoma. With reference to the causes nothing definite is 
known. Recent theories concerning bacterial and protozoan 
irritants have not been sustained. 

ForRMS.-—Sarcomata are characterized by many different 
forms. According to the structure and the forms of the con- 
nective-tissue cells the following principal types are recognized : 

a) Round-celled sarcomata are composed of 
large or small round-cells (large and small round- 
celled sarcomata). The small reund-celled sarcomata 
are especially malignant. They consist almost wholly of 
small round-cells, similar to white blood-corpuscles ; occa- 
sionally they are combined with ameboid connective-tissue 
cells which multiply very rapidly. The consistency, there- 
fore, is soft, marrow-like (medullary sarcoma), andthe 
growth is very rapid. 

b) Spindle-celled sarcoma is composed essen- 
tially of spindle-cells; it often develops from a fibroma 
(fibrosarcoma). 

c) Giant-celled sarcoma is very malignant; 
it is usually found in the bone-marrow (myelogenous 
sarcoma, myeloid). 

d) Stéllate or “Netzzellen” Satcouae 
usually arise from myxomata (myosarcoma). 

e) Sarcomata with polymorphous formation 
are composed of various forms of connective-tissue cells: 
round-cells, spindle-cells, giant-cells, retic- 
ular cells; there are many combinations of these cells 
(combined sarcoma). ) 

f) Alveolar sarcoma is characterized by a gland- 


SARCOMA 127 
and cancer-like alveolar structure; under certain conditions it 
is difficult to differentiate it from carcinoma. The alveolar, 
small and large round-celled sarcomata are of special import- 
ance; lymphosarcomata are examples of the former. 
In contrast to carcinomata of a similar alveolar structure, the 
alveolar sarcomata show an intercellular substance among their 
cells. 

Bp) Angiosarcomata or endotheliomata 
(endotheliosarcoma, endothelial cancer, plexiform angiosar- 
coma, plexiform angioma, cylindroma, perithelioma) are 
angiomata with a sarcomatous proliferation 
of the cells of the vessel-walls. They develop 
from the following sources: the endothelial cells of the intima 
and perithelium (adventia) of the blood- and lymph-vessels, 
the lymph-cells of the connective tissue, as well as the endo- 
thelium of the pleura, the peritoneum, the dura, and the pia. 
They have been recently differentiated, then, as he man gio- 
sarcomata (angiosarcoma of the blood-vessels) and 
lymphangiosarcomata (of the lymph-vessels). De- 
pending on their origin onthe inner or outer wall of the 
vessel they are termed intravascular (endothelial), and 
perivascular (perithelial). Angiosarcomata are very 
malignant ; they show a tendency to hemorrhage and hyaline 
degeneration. They are easily confused with carcinomata. 
They are characterized by pronounced thickening of the 
vessel-walls, of hyaline appearance, and are frequently of 
cylindrical form. 


The following belong to the angiosarcomata or endothe- 
_liomata : cholesteatoma or margaritoma on the 
venous plexus of the brain of the horse (endothelioma with a 
deposit of cholesterin crystals), psammomata or sand- 
tumors of the brain (endothelial tumors with a deposit of car- 
bonate of lime), and xanthomata or xanthelasma (fatty 
endotheliomata, endothelioma lipomatosum ; according to others 
a form of lipoma). 

h) Melanosarcoma or melanoma (pigment sar- 
coma) is a brown or black, pigmented tumor that is often very 
malignant; it develops rapidly and is frequently recurrent. It 


128 SARCOMA 


spreads by metastasis and is most often seen in grey horses, it 
may, however, occur in dark horses (brown, chestnut, black), 
as well as in cattle, sheep, and dogs. Histologically melano- 
sarcoma is partly round-celled and alveolar (soft, malignant 
new-formation), partly spindle-celled or fibrosarcoma (firm, 
relatively benign tumor). Formerly the pigment was sup- 
posed to be the coloring matter of the blood. According to 
recent investigations, however, the pigment (hippomelanin) 
frequently contains no iron ; it arises from specific embryonal, 
pigment-forming cells, the melanocytes (Berdez and 
Nencki, Lieber). According to Ribbert pigmént 
tumors are formed from the chromatophores. Accord- 
ing to Joss the pigment is developed from the albumenous 
material of the blood through a specific, metabolic activity of 
the sarcomatous cells (high percent of sulphur). Melanosis 
is differentiated from melanoma by pigment infiltration, with- 
out tumor formation, in the subcutem, in sheaths of muscles, 
and in internal organs (calves, cattle, horses). 
OCCURRENCE.—Sarcomata are very common in the domes- 
tic animals; they are especially common in cattle, horses, and 


dogs. Among 54 sarcomata observed by Semmer, 30 were of — 


the dog, 12 of the horse, 4 of cattle, and 2 of swine. Among 


643 new formations that I have operated upon in the dog, 44 
were sarcomata ; atnong 200 new formations operated upon in 
the horse, 50 were sarcomata. roma surgical standpoint the 
following sarcomata are of importance : . 

1. SARCOMATA OF THE BONES.—These are partly periosteal, 
partly central (myelogenous) sarcomata, partly osteosarcomata. 
They are found in horses and cattle, especially in the nasal 
cavities and maxillary sinuses, where they may 
develop from the ethmoid bone, the turbinated bones, the nasal 
bones, the zygoma, or the superior maxillary bones. They 
give riseto stenosis, cause chronic catarrh, and may 
extendintothe frontal sinus, the oral cavity, the 
orbit, the cavities formed by the Spite 
bone, and to other bones of the head. Indogs 
they are most often found in the oral cavity, andon the 
superior maxilla, less frequently on the inferior maxilla. 


Ue ce 


SARCOMA 129 


They develop on the gums in the form of proliferations that 
are nodular, circumscribed, compact, as hard as bone or carti- 
lage, and painless ; the surface is rough, irregular, granular, 
or lobulated; they cause the teeth to become loosened, dis- 
placed, raised, and crowded apart (epulis). Central osteo- 
sarcomata also occur in horses, dogs, cattle, and swine; they 
may be solitary or multiple, at times generalized ; they occur 
on the humerus, the scapula, on the femur, on 
the tibia (lameness), the frontal bone, the petrous 
portion of the temporal bone (facial paralysis), 
onthe bones of the cranium, neck, and verte- 
bral column. Kammerman saw a case of spindle- 
celled sarcoma in the cow; it passed through the intervertebral 
foramen of the atlastothecervical marrow. Dieckerhoff 
and Frohner have observed diffuse myelogenous sarcomata 
in horses and dogs. A sarcoma of the guttural pouch caused 
hemiplegia by penetrating the vertebral canal of a horse; an- 
other in the same place caused paralysis of the tongue ( Hal- 
lander). Spinal paralysis is caused in horses, cattle, and 
dogs by pressure on the spinal cord from hard sarcomata 
Moorrwachter, Dexler, and others). In swine a 


form of so-called snuffle-disease is caused by sarcoma 


of the facial bones. 

2. LYMPHOSARCOMA.—This is most often found in 
horses and dogs. In horses, according to my experience, they 
are soft, sometimes fluctuating and cystic tumors. They vary 
in size from ahen’s egg to that of a man’s head ; they are often 
multiple, and are found in the intermaxillary region 
(suspected glanders), in the region of the larynx 


-(goitre-like tumors),onthe neck, inthe region of the 


shoulder (a form of shoulder abscess), on the anterior 


‘portion of the thorax, inthe pelvic glands, on both 


sides of the sheath, etc. In one case in a horse that was suf- 
fering from ‘‘intermittent lameness’’ I found a lymphosar- 
coma that involved the left iliac and femoral arteries ; it was 
as large asa man’s fist. I have also found lymphosarcomata 
in dogs, especially on the neck and in the region of the pubis ; 
they are often multiple. In cattle lymphosarcomata as large 


130 SARCOMA: 


as one’s fist are found in the thoracic region, in the flank, and 
in the sacral glands (Poncet). Stricker succeeded in 
transmitting lymphosarcoma of a dog to thirty-one other dogs 
by means of subcutaneous and intraperitoneal injections. 

3. SARCOMATA OF THE SKIN AND Mucous MEMBRANES. 
—These form circumscribed and multiple, or diffuse and ex- 
tensive tumors of soft or hard consistence. They may appear 
nodular, lobulated, fungus-hke or villous. In cattle and 
horses they are found in the cervical and shoulder regions ; 
in these places they form extensive tumors which may lead to 
passive edema or suppuration; they may extend to the 
thoracic cavity and cause asphyxia from pressure on the 
trachea; generalization with metastatic formation in the in- 
ternal organs is common. ‘They also occur in other parts of 
the body; namely, on the extremities of dogs; on the lips, 
tongue, rectum, sheath, and fleshy-frog of the horse; on the 
vulva and vagina of cows (cause of dystocia). Eberlein 
has described a pendulous sarcoma on the inferior maxilla of 
ahorse. Girotti observed a myxosarcoma on the umbilicus 
of a calf. Gorig has described a multiple sarcoma on the 
throat and thorax of a hen. 

4. SARCOMATA OF THE EvES.—These are most often seen 
in horses, dogs, and cats. They occur either in the form of a 
round-celled sarcoma of the orbit where they cause strabis- 
mus (squint) and exophthalmos, as well as degeneration of 
the neighboring bones, and even press into the frontal sinuses, 
the maxillary sinuses, and the cerebral cavity (Emmerich, 
personal observations), or a round-celled sarcoma (gliosar- | 
coma) of the retina, or asa melanosarcoma of the choroid 
(Bayer). 

5. SARCOMATA OF THE TESTICLES, UDDER, THYROID 
AND PAROTID GLANDS.—These result in a circumscribed en- 
largement, or enlargement of the entire glands, occasionally 
the enlargement is enormous. According to my experience 
they are relatively most frequent in displaced testicles, and 
in the mammae of bitches, as well as in the thyroid glands of 
the horse. Walley found ina horse (cryptorchid) a round- 
celled sarcoma of the testicles that weighed 35 kg. I have 


SARCOMA 131 


likewise diagnosed and removed from two stallions, two small 
round-celled sarcomata of the testicles as large as a child’s 
head. Schuemacher has observed a similar sarcoma of 
the testicles in a stallion. Garino has described twelve 
eases of fibrosarcoma of the testicles in breeding animals 
(eleven were unilaterial, one was bilateral) ; the testicles were 
enlarged three or four times their usual size, 214-3 kg., the 
spermatic cord was thickened as far as the inguinal ring. 
Sarcomata also occur in the ovaries and kidneys. Resow 
described a primary round-celled sarcoma of the udder of a cow. 

6. SUBPERITONEAL AND SUBPLEURAL SARCOMATA.— 
These are apparently common in cattle, horses, and dogs; this 
is especially true of sarcoma of the abdominal cavity, the 
pelvic cavity, and the intestines. As a rule they cannot be 
operated and are of no surgical importance. It is a peculiar 
fact that many times they cause no obvious external 
symptoms. They are usually first discovered during a post 
mortem. In other cases they are the cause of colic (stenosis 
of the small intestines), and general emaciation, as well as 
cachexia. Sarcoma of the pelvic cavity may result in an in- 
curable obstruction to parturition ; this is due to adhesions, or 
to compression of the uterus and vagina. Primary or metas- 
tatic sarcomata of the lungs, liver, spleen, kid- 
neys, brain, heart, bladder, inner lymph-glands, 
ete., are of no surgical importance. 

7. MELANOSARCOMA.—Thisis most often seen in horses ; 
it also occurs in asses, oxen, sheep, dogs, and goats; it may 
be isolated, multiple, or generalized. It is most often seen in 
old grey horses. They are usually found in the following 
Places: in the vicinity of the anus, the vulva, the 
Vagina, the tail, the sheath and the penis, the 
shoulder region—especially at the point of attachment 
of the serratus to the scapula—the eyelids, the 
lips, as well as the region of the cheeks, the masse- 
ters, andthe parotid. They may arise in any organ or 
in any partof the body. ‘They have been found by others in 
muscles, bones, and lymph-glands. Mauri has 
described a case of melanoma on the body of the third lumbar 


132 ; SARCOMA ; 


vertebra, which led to pressure of the spinal marrow witha 
subsequent spinal paralysis. Vache has observed a similar 
case of pressure atrophy of the lumbar marrow in a seventeen- 
year-old mare. In other cases compression of the brain, in- 
dividual cranial nerves (facial), the ischiadicus, and the 
femoral artery, leads to paralytic conditions. I observed a case 
of fragilitas ossium (multiple fracture of the pelvis and ribs) 
in a horse affected with general melanosarcomatosis. In several 
others, melanosarcoma in the perirectal connective tissue was 
the cause of chronic colic due to obstruction. Roder observed 
a case of stenosis of the urethra in a horse caused by melano- 
sarcoma of the pelvis. Many melanosarcomata have a tendency 
to ulceration and suppuration, so that, for example, cancer-like 
ulcers are present on the skin, hemorrhage occurs in the nasal 
cavities (personal observations). Internal melanosarcomata 
may rupture and terminate in fatal hemorrhages. Generaliza- 
tion is very frequently observed. Metastases develop in the 
lungs, liver, heart, in the lymph-glands, ete. 
With reference to the prognosis it may be remarked that in a 
great number of cases, even in the geneéral- 
ized form,’ general, derangements @itjeueeeom 
observed. Melanosarcomata are usually of incidental im- 
portance in slaughtered horses that are otherwise normal. In 
St. Petersburg in the years 1892-93, from 7000 slaughtered © 
horses, 36 cases of melanosarcoma, of which 8 were general- 
ized, were observed (Sawaitow). Budnowski found 
I2 per cent of the First Sovereign Hussar Regiment (only 
grey horses!) affected with melanoma; in 63 horses the 
melanomata were from the size of a pea to that of a hazel 
nut ; complications dangerous to life had occurred only four 
timesin the regiment (seat in the pelvic cavity, on the omen- 
tum, beneath the vertebral column, in the parotid). In other 
cases melanomata are very malignant, they undergo ichorous 
degeneration and chronic hemorrhage ; the patient suffers from 
anemia and general cachexia. The soft, pigmented, round- 
celled sarcomata have a special tendency to result in the latter 
course. 

TREATMENT.—Sarcomata should be extirpated as early 
as possible. Treatment is unavailable when metastatic 


Sao 


CARCINOMA 133 


formation has already commenced. In the latter case especially 
the prognosis of melanosarcoma is very unfavorable ; satisfac- 
tory results are obtainable only in solitary, firm, benign melano- 
mata. The various conflicting statements concerning the value 
of operative treatment for melanomata are explained by the 
great variations in character of these tumors: benign; very 
malignant degree of extension. When the removal of the 
tumor is incomplete, remnants of the sarcoma remain and 
furnish a source for recurrence. Melanosarcomata are operated 
exactly like other sarcomata; I have successfully extirpated 
them inthe horse. Delamotte, toprevent recurrence fol- 
lowing extirpation with the knife cauterized the wound and 
then covered it with arsenic ; this possesses an affinity for sar- 
comatous cells (?). 


Bea riPpoEUIAT, NEOPLASMS. 
I. CARCINOMA. 


NATURE.—Carcinoma or cancer isan atypical 


Bemprthnelial neoplasm; it has the property of 


unlimited growth. All carcinomata are formed essen- 
tially of epithelial cells, which lie in a connective-tissue stroma 
(cancer-stroma) in the form of cancer-plugs, cancer-nests, or 
cancer-nodules. ‘They proliferate into the neighboring tissues, 
break down the lymph-vessels and blood-vessels thus leading 
to metastatic formations. At first the metastasis is 
confined to the neighboring lymph-glands, afterwards it de- 
velops in the form of a generalized carcinomatosis of the in- 
ternal organs of the body. General derangement of the 


nutrition thus produced—so-called cancerous cachexia 


—is due to a form of auto-intoxication, that is, a general 
chronic poisoning derived from the cancerous new-formation. 
All carcinomata are derived from epithelial 
tissues (Thiersch, Waldeyer). Virchow thought 
that connective-tissue cells were transformed into cancer-cells, 
this theory has not yet been demonstrated. 


134 CARCINOMA 


Forms.—According to the different varieties of epithelium 
(squamous epithelium, cylindrical epithelium, glandular epi- 
thelium) the following forms are recognized : 

(a) Squamous-celled carcinomata or can- 
eroids are found on the skin, oral mucous membranes, 
mucous membranes of the pharynx and esophagus, conjunctival — 
mucous membrane, mucous membranes of the vagina and blad- 
der, of the sheath, and of the penis. 

(b) Cylindrical-celled cancer is found on the 
mucous membranes of the stomach, intestines, and uterus. 

(c) Glandular-celled cancer develops in the 
testicles, mamme, thyroid gland, thymus gland, parotid, 
prostate, in the sudoriferous and sebaceous glands of the skin, 
in the mucous glands of the mucous membranes, in the liver, 
in the pancreas, in the kidneys, and the suprarenal glands. 

According to the consistence and form they are classified 
as follows: hard, firm carcinomata with an abundance of con- 
nective tissue (schirrhus, fibrocarcinoma); soft, 
carcinomata of the consistence of the brain or spinal marrow 
(medullary cancer, medultary carcimOmege 
mucous and gelatinous cancer (carcinoma myxomato- 
sum and gelatinosum); pigmented cancer (melano- 
carcinoma); villous cancer (carcinoma papilloma- 
tosum or villosum) and others. 

ETIoLOGy.—The origin of carcinomata is no better un- 
derstood than that of other tumors. A series of etiological 
factors has been advanced to explain their occurrence in man ; 
the same factors, with nothing added, have found place in 
veterinary science (see below). 

1. Age, sex, nutrition, and heredity are con- 
sidered predisposing influences for the development of cancer, 
Experience among men has taught that carcinoma pre- 
ponderates among those advanced in age. It 
may develop in any period of life but is seldom seen in a 
person under forty years old. It is most often seen in people 
between the ages of forty-five and sixty-five (50 per cent of 
all cases). In animals (dogs) ona basis of material composed 
of 262 cases I have observed that old dogs were the only ones 


CARCINOMA 135 


affected with carcinoma; I have never seen a case of cancer in 
a dog under two yearsof age. Of the dogs affected eighty- 
seven per cent were over five years old, fifty-four per cent 
were over seven years. Carcinoma forms a contrast to sar- 
coma ; the latter frequently occurs in young puppies. Similar 
conditions have been observed in American cattle by Loeb 
and Jobson; of the forty-nine cases published all were in 
Cows Over six years old. Foran explanation of the influence 
of age on the existence of cancer (diminished resistance of the 
connective-tissue stroma in contrast to the proliferating 
epithelial cells) see page Ior. 

With reference to the influence of sex, it has been main- 
tained that in the human family the increased functional 
activity of the sexual organs, especially the uterus and 
mammee in females, predisposes to carcinomatous disease of 
these organs. The relation appears to be similar in the dog, 
where carcinomata of the mamme are seemingly frequent. 
This theory cannot be applied to cows, however, where for 
economic reasons, glandular activity and milk production are 
most highly developed. Carcinoma of the udder and uterus 
of the cow has apparently been observed in only a very few 
cases (up to 1898 I have counted only three cases in the litera- 
ture; Guillebeau has recently published records of seven- 
teen cases) although these organs are carefully examined in 
abbatoirs. 

Nourishment exerts an influence on the develop- 
ment of cancer, in that it develops more frequently in those 
who eat meat than in vegetarians (observations in England). 
The same comparison has been made in the lower animals; in 
the carnivorous animals (cats, dogs) carcinomata are very 
common ; while in herbivora (cattle, horses) cancers are prac- 
tically unseen. This theory is valid only in dogs, which, ac- 
cording to my own experience, are the most frequent sufferers 
from carcinoma. ‘The majority of the neoplasms in the dog 
belong to this class. On the other hand, the statement that 
the horse, as a carniverous animal, practically never suffers 
from cancer is incorrect ; in the years 1895-1902 I operated on 
twenty-five cases of cancer in the horse. Swine, on the other 


136 CARCINOMA 


hand—omniverous animals that consume flesh—are seldom 
affected with carcinoma; this has been demonstrated by ex- 
perience in the abbatoir. ‘Therefore, for the want of a better 
cause, it is not so much the nourishment, as the species of 
the animal that has a predisposing influence on the develop- 
ment of cancer. Concerning the importance of heredity 
in animals, which by many is considered the principal etiological 
factor in man (compare with Cohnheim’s theory of the scat- 
tered embryonic cells, page 100), nothing definite is known. 
Notwithstanding the fact that carcinomata develop only in old - 
animals, the possibility of heredity among them should not be 
forgotten. For this reason caution should be employed in the 
use of breeding animals that suffer from cancer. 

2. Traumatic and chemical irritatiogegeage 
recently been placed in the foreground as etiological factors for 
the production of cancerin man. ‘This theory is supported by 
the appearance of cancer in the following places : the so-called 
cicatricial cancer which develops in a cicatrix under the in- 
fluence of a chronic inflammation ; the frequency of cancer of 
the gall-bladder when under the influence of mechanical irrita- 
tion from gall-stones; the appearance of cancer on the lips, 
tongue, and larynx of tobacco-smokers ; as well as upon the 
skin of chimney-sweeps, workersin tar, paraffine, etc. Accord- 
ing to Brosch continual irritation of granulating cutaneous 
wounds with xylol developed artificial proliferations of the 
epithelium in guinea-pigs ; it was alleged that these could not 
be differentiated from incipient carcinomata of the skin (? ). 
According to M’Fadyean cancer of the skin occurs in Austra; 
lian cattle after branding ({? ). According to Eggeling cutane- 
ous cancer of the inferior maxilla occurs in swine in an enzo- 
otic form as a result of feeding trom troughs (? ). 

Cancer has not yet been experimentally produced by the 
influence of continued mechanical or chemical irritants, for 
example, applications of tar to dogs and rats (Hanau). 
Probably the irritants are only able to cause cancer when there 
exists a primary local or general predisposition; they are not 
essential etiological factors, but exert an accessory influence. 
The fact should also be noted that carcinomata frequently de- 


os") 
n : 
vs 


CARCINOMA 137 


velop in organs that are protected against external irritation 
(prostate and thyroid gland of the dog, cavities of the head, 
thoracic cavity, abdominal cavity in the horse). Thetheory 
Mace cancer of, the lips and tongu®e of ‘ani- 
Peeberirequently develops from external i1/A- 
tants is also wrong from a veterinary stand- 
point. Onthe contrary, they are very seldom produced in 
his manner. I have seen only one case, and have found only 
two cases mentioned in literature. 

3. Parasitic infection has in recent years been 
frequently considered a cause of cancer. The parasitic 
mouure of cancer has not yet been satisfac- 
torily demonstrated; its existence is improb- 
able. Bacteria have also been credited as the cause of 
cancer (cancer-bacillus of Scheuerlen); so far they have 
all proved to be inocuous accidental saprophytes (proteus 
mirabilis). The cancer-bacillus recently described by 
Schuller has proved to be a contamination of the prepara- 
tion with cork-cells. Also the protozoa or coccidia, 
which, according to Pfeiffer, Thoma, Adamkiewicz, 
v. Leyden, and others, existed in a special form within 
the cancer-cells, have proved to be degenerated forms 
Brrepithelial cells, “as well as degenerated 
nuclei and nuclear bodies. ‘The following condi- 
tions when examined under the microscope may be confused 
with coccidia: endogenous new-formations of cells; incom- 
plete cellular division; invagination of individual cells into 
each other ; the presence of red and white blood-corpuscles in 
cells ; pathological nuclear division ; mucous, colloid, hyaline, 
and vacuolar degenerations of the cell-protoplasm, pathological 
cornification ; degenerations of the nucleus, the nuclear 


bodies, and the nuclear membrane. 


Metastasis, which is common in cancer, as well as an 
occasional successful artificial transplantation of 
the cancer in both men and animals (Hanau, Geiss- 
ler, Hahn, v.Bergmann, Wehr, Cornil, Jensen) 
are cited as examples of the parasitic nature of the cancerous 
neoplasm. In contrast to the few successful cases mentioned 


138 CARCINOMA 


are the unsuccessful attempts at transmission of many other 
investigators (Klebs, Tillman, Israel, Shattock 
and Ballance, Alberts, “Putz, Trasbotpeeeue 
play, Catzin, Cadiot, Gilbert, Gratiay=Dseme 
aux, English Cancer Commission, and others), 
the parasitic nature is in no way proved by the artificial trans- 
mission of cancer. ‘The successful results of. inoculations are 
in reality nothing more than transplantations, or artificial 
metastatic formations; the specific pathological epithelial cells 
have been transplanted, not the parasite of carcinoma, the new 
cancer-proliferation develops from these cells. It has also 
occurred that, in inoculation experiments carried on in man, 
self-infection has taken place in those already affected. In 
these cases the principal factor, a predisposition, was present. 


CANCER IN MICE.—Jensen (Experimentelle Untersuchungen 
aber Krebs bei Mausen. Zentralblatt fir Bakteriologie, 1903, Bd. 
XXXIV, S. 28) has recently transmitted a carcinomatous tumor in a 
mouse over nineteen generationsof white and grey mice (not, however, 
to otheranimals). The transmission wasa simple transplantation. 
Mere crushing of the cells of the tumor produced negative results. 
Proof of the parasitic nature of the carcinoma could 
not be found. On the other hand, therapeutic experiments with ~ 
blood-serum from vaccinated rabbits produced good results in 
diseased mice. The preparation of a serum to produce immunity is very 
difficult; the results are also uncertaine Jensen, at least, 
thought that there was no basis for the introduction 
of hope from the serum-treatment of cancer in man: 

PSEUDO-CARCINOMA.—Zschokke has observed two cases of a 
cancer-like tumor on the upper lips and intermaxillary space in horses ; 
it was caused by a fibrillar fungus (actinophytosis), and was as large as. 
one’s fist (Schweizer Archiv. 1903). It consisted of a connective-tissue 
stroma with compartment-like enclosures (carcinomatous structure) ,. 
these contained foci of leucocytes, and peculiar fungiform 
structures with filiform processes (degenerated filimentary fungi). 
In all probability the infection occurred from without through wounds. 
and epithelial defects in the oral mucous membrane. The fungus re- 
sembled the actinomyces fungus, it varied from it, however, in certain 
respects. 


OCCURRENCE.—Localization of cancer is different in ani- 
malsthaninmen. Horses and dogs are the only animals 
of essential importance; in cattle, sheep, goats, swine and 


CARCINOMA 139 


cats, carcinomata are only occasionally of surgical importance. 
The following are the most important special forms: 

1. CARCINOMA OF THE SKIN.—This is most often found 
in dogs; according to my experience it most frequently 
occurs in the following places: on the head (ears and 
eyelids), onthe back, onthe tiailjon the prepuce; 
scrotum, inthevicinity ofthe anus and on the limbs. 
In the horse the favorite places for the development of 
cancer appear to be on the glans penis, the vulva and 
clitoris, on the tail and sheath, as well as in the 
region of the bulbs of the foot. Carcinomata 
of the penis form tuft-like, villous, often suppurative 
tumors; they usually attack the prepuce and lead to metas- 
tases in the inguinal glands (Leisering, Moller, per- 
sonal observations). Macroscopic appearance of carcinoma 
is extremely variable according to the age and location of 
the tumor. Carcinomata of the skin usually present the fol- 
lowing appearance: they are attached tothe skin, 
haveatendencyto ulceration and infiltration 
of the adjacent tissues, and are firm in con- 
sistence; the surface is nodular and rough; 
the margins of the ulcers are wall-like and 
Mone nodular wtormation is present in the 
Mreinity; thereéisasecondary swelling of the 
neighboring lymph-glands. Theneoplasms may be 
circumscribed or diffuse ; large areas of the skin may become 
ulcerative, nodular, thick, lardaceous, ichorous, and trans- 
formed into immense tumor-masses that are foul in appear- 
anceand odor. Onthepenis, carcinomataform tumors that 
are papillomatous, villous, fissured, and often very large. 

2. CARCINOMA OF THE Mucous MEMBRANES.—These 
are often found in superior maxillary sinuses of 
the horse. According to my observations they form firm, 
lobulated, hemorrhagic, very rapidly developing tumors. The 
neoplasms are permeated with hemorrhagic foci and contain a 
fluid similar to that found in the medullary substance of the 
brain ; they usually arise from the mucous membranes of the 
oral and pharyngeal cavities (Squamous-celledcancer 


140 CARCINOMA 


of the hard gums) andlead to loosening of the teeth, 
penetration to the nasal cavities, maxillary sinuses, and even 
the frontal sinus, they also result in swelling of the intermax- 
illary lymph-glands (metastatic formation). Similar tumors 
have been observed inthe nasal cavities of the horse; 
in this case the squamous-celled cancer originated from the 
squamous epithelium of the lachrymal duct (Montfallett). 
Carcinomata are further found in the pharyngeal cavity of 
the dog, as well as in the turbinated bones and 
esophagus ofthehorse. In the latter place, under certain 
conditions, they may lead to perforation and fatal pleuritis ; a 
case of this kind has been described by Lorenz. Carci- 
nomata are further observed on the mucous membranes 
of the eyes in horses; they either involve simply the 
membrana nictatans (personal observations), or the 
conjunctival schlera (Bayer), or penetrate the 
entire orbit destroying the neighboring bones, especially 
the frontal bone, the superior maxillary bone, the zygoma, 
and the lachrymal bone, even penetrating into the frontal and 
superior maxillary sinuses(Leisering, Moller, Hichler, 
personal observations). Among two and one half million 
cattle slaughtered in Chicago in 1899 Loeb and Jobson 
claim to have found forty-eight cases of squamous-celled cancer 
of the lachrymal caruncle (at first it is about the thickness of 
one’s finger and papillomatous ; it afterwards becomes exten- 
sive, fissured, and covered with blood-coagulum. 

Carcinomata are also frequently found in the vagina, 
on the clitoris (Hberlein, Hennig, Nadav 
inthe uterus (Guillebeau), in the bladder, as 
wellason the skin and mucous membranes of the 
prepuce of dogs, horses and cattle. Olt has described a 
case of cancer of the rectum in the horse (squamous- 
celled cancer, congenital wandering of squamous epithelium 
to the mucous membrane of the rectum). Carcinomata 
of the bladder are usually in the form of villiform can- 
cers; they present cauliflower-like, villous, tufted, fissured 
proliferations of the consistence of mucus, and have a firm 
base. They lead to hemorrhage and ichorous degenerations, 


CARCINOMA 14! 


as well asto nodular formations in. their immediate vicinity 
(hemorrhagic, ichorous, fetid, sedimentous urine) ; occasion- 
ally they extend to the peritoneum and the abdominal viscera, 
or result in a fatal perforating peritonitis (Siedamgro- 
feiwy, witt, Prlug, Esser, Bang, Demeurisse, 
Bollinger, and others). A case of cancer of the tongue 
has been observed in a twelve-year-old cat (M’ Fadyean); 
he found a cancerous ulcer on the ventral surface of the tongue, 
from here plug-like carcinomatous proliferations penetrated 
the entire tongue. Pflug and Leblanc have described 
a case of cancer of the tongue in cattle, and cancer of 
the lips inadog. Inthe larynx (epiglottis) only one 
carcinoma has been observed (Casper). Cancer of 
the stomach is far less common in animals than in man; 
veterinary literature contains records of only a very few cases 
imetiiennorsesand doe COltmann, Roloff, <Kitt; 
Eberlein, Durbeck). 

3. CARCINOMATA OF GLANDS.—These are most frequently 
observed in the mammee of the bitch ; I have operated eighteen 
cases. Their consistence and size are extremely variable ; 
pain and heat are usually absent; the skin is either intact, 
or possesses ulcerative foci and undergoes. cancerous infiltra- 
tion; the adjacent lymph-glands are frequently swollen. Carci- 
nomata of the mamme are sometimes soft, and may even fluctu- 
ate as a result of cystic degeneration. Many cases have been 
observed by Bang, Kitt, Rabe, Johne, Moller, 
Putz, Pflug, Stenzel, andothers. In cattle, horses, 
and swine, on the other hand, cancers of the mamme seldom 
vecuny (-Cadiot:): 

Carcinomata of the testicles are common in horse 
and dogs; they often result in a marked enlargement of the 
testicles (one form of so-called sarcocele), infiltration of the 
spermatic cord, swelling of the inguinal glands, carcinomatosis | 
of the peritoneum, as well as metastatic formation; they are 
occasionally observed in cryptorchids, and are not uncommon 
in the laterally displaced testicles of the dog. Cases of cancer 
of the testicles have been described by Leisering, Stock- 
PletnyikOllvGuillebeau, Siedamgrotzky, Mol- 
fer, hrohner, Trasbot, Cadiot, and others. 


142 CARCINOMA 


Carcinoma of the thyroid gland occurs most fre- 
quently in horses and dogs; it occurs in the form of 
goitre (struma maligna, struma carcinomatosa). 
It is characterized by rapid development, emaciation and 
cachexia of the animal, as well as metastatic formations in the 
lungs (breaking down of the jugular) and other internal 
organs, followed by a fatal termination (Johne, Kitt, 
Siedamgrotzky, Moller, Zschokke, Hutyram 
Cadiot, personal observations). In dogs thyroid-gland 
cancers may reach the size of two fists; in horses they may 
attain twice the size of a man’s head. ‘They often embrace 
the trachea and esophagus, and occasionally extend as far as 
the thoracic cavity. 

Cancer of the prostate in dogs is of special importance 
as it can be diagnosed per rectum, it often forms a tumor as 
large as one’s fist, and is the cause of habitual constipation 
(personal observations). Only one case of cancer of the pros- 
tate in the horse has been described (Cadiot). Carcinomata 
of the anus are very common in dogs ; they originate from the 
anal glands (compared with these, carcinomata of the rectum 
are very rare). ‘They form uneven, nodular, warty, cauli- 
flower or fungus-like neoplasms; they are fissured and lobu- 
lated ; occasionally they are also pedunculated, soft, and 
painless. 

Siedamgrotzky has described a cancerous neoplasm . 
that originated in thethymus gland of the horse; it led 
to metastatic formation in the inferior cervical glands, the 
principal lymph-vessels, and the retro-pharyngeal and sub- 
maxillary lpmph-glands, as well as to extensive schlerosis of 
the subcutaneous and intermuscular connective tissue. It 
presented the clinical appearance of a high-grade edema of the 
skin on the dependent portions of the head, neck, and thorax. 

Hinrichsen observed a multiple cancer of the 
lymph-glands of the head (medullary carcinoma) in two 
horses, it was characterized by metastases in the internal 
organs, inthe glands inthe vicinity of the shoulder and arm, 
and the axillary glands; pronounced edema was also present 
in the same vicinity. Similar cases of primary cancers of the 


CARCINOMA 143 


lymph-glands in horses and dogs have been described by 
Leisering, Casper, Kitt, and Frohner. Petit 
has observed one case of carcinoma of the parotid in the cat. 

4. CARCINOMA OF THE INTERNAL ORGANS.—They often 
occur in horses, dogs, and cattle, but are of trivial surgical 
importance. They areoften found on the pleura, on the 
peritoneum, in the omentum, and inthe mediastinal, 
mesenteric, and lumbar lymph-glands, where 
they are often multiple, characterized by secondary metastases, 
and more or less generalized. Enormous masses of tumors are 
often formed, they involve the lungs and other adjacent vis- 
cera, and even penetrate the walls of the thoracic and abdomi- 
nal cavities. Carcinomata have also been observed in the 
liver, inthe kidneys, in the suprarenal glands, 
inthe ovaries (10to 20 kg. in weight, occasionally fatal 
through hemorrhage and peritonitis), in the rumen, stom- 
mememintestines, in the lungs, in the brain, and 
spinalmarrow (metastases). A cancerous metastasis in 
the horse has led to pressure-paralysis of the spinal cord 
(Alfort Clinic). 

-TREATMENT.—As in sarcomata, so in carcinomata, the 
earliest possible extirpation forms the basis for 
successful treatment. Caustics are rarely indicated. Opera- 
tive removal of the following forms is relatively simple: car- 
cinomata of the skin and anus, as well as carcinomata of the 
membrana nictitansandeyelids. Carcinomata of the mamme, 
penis, and testicles are removed by amputation, or cas- 
tration. It is more difficult to treat proliferating carcino- 
mata in the cavities of the head (trepanation). Extir- 
pation of cancer of the thyroid gland is especially difficult © 


_ (severe hemorrhage, cachexia strumapriva). All internal 


carcinomata are incurable (pleura, peritoneum, lungs, internal 
lymph-glands, liver, kidneys, bladder, stomach, intestines, 
etc. ); the same is true of generalized carcinomatosis. Arsenic, 
which was formerly administered as an internal specific, acts 
only asa stimulant to metabolism and nourishment. Inocu- 
lation of the cancer with erysipelas has occasionally been fol- 
lowed by recovery in man, it is seldom employed at the pres- 


144 PAPILLOMA 


ent time as it endangers the life of the patient. Serum- 
theraphy (injection of blood-serum from animals affected 
with cancer, or from animals into which masses of cancer 
have been inoculated) has not proved a success (Cadiot, 
and others). This serum seems to possess a specific action 
for experimental animals (mice) (Jensen). Recently, 
Rontgen rays and radium rays have been employed to cure 
cancer (this method results only in the destruction of the 
cancer-cells). 


STATISTICS OF CANCER IN ANIMALS.—Sticker has collected re- 
ports from veterinary literature on 1217 cases of cancer (332 horses, 766 
dogs, 78 cattle, 21 cats, 12 swine, 8 sheepand goats). According to fre- 
quency they were arranged as follows: 

1. Horse: penis, nasal and adjacent cavities (52 cases), kidneys 
(29), skin (22), vagina (18), eyes and urinary bladder (14), lungs and 
testicles (13), gingivee (11), anus, stomach, thyroid gland, uterus (8), 


larynx (7), etc. 

2. Cattle: uterus (16), kidneys (10), bladder (9), ovaries and 
stomach (6), liver (4), vagina and lungs (3), etc. 

3. Dog: mamme (341), skin (166), anus (89), thyroid gland and 
lungs (10). 

4. Cat: skin (6). mamme (5), lungs (3), liver (2). 

5. Swine: kidneys (7), skin (2). 


It.  PAPILUOMSA, 


NATURE AND Forms.—Papilloma was formerly considered 
a connective-tissue proliferation of the papillary body, and 
classified with the fibromata (papillary fibroma) ; 
recently it has been placed with the epithelial neoplasms 
(papillary epithelioma) and is considered a mixed 
tumor (fibro-epithelial neoplasm). It consists of a 
hyperplasia of the epithelium of the skin and 
mucous membranes with a simultaneous pro- 
liferation of the papillary body (connective-tissue 
and vascular new-formation). ‘Two forms of papillomata are 
recognized : 

a) Warts (verruca) are hard, dry, horny papillomata 
derived from the epithelium of the skin. 

b) Condyloma (fig-wart) is a soft non-cornified,evascular 


as 
ek 
tay 


Sa PAPILLOMA ee 


ee rcting papilloma of the skin and mucous membrane 
Biesinted, broad condyloma) ; it is moist on the surface (fig- 
iy wart, moist wart), and has the appearance of cauliflower or 
~ eockscomb. 

a ErioLocy.—Chronic inflammatory irritants play 
- animportant part in the development of papillomata. The 
_ S0- -called verrucose form of scratches in the horse is a multiple 
warty formation on the skin of the fetlock; it is the product 
of a chronic dermatitis or infectious inflammation of the 
{ _ skin. They have also been seen on the lips of horses and 
cattle that have been pastured in fields of stubble; such 
| f “cases are due to inflammatory processes on the skin and mucous 
a yi membranes. Chronic irritants (excretions) in the vicinity of 
_ the vulva and anus may also be considered occasional causes 
ot -papillomatous neoplasms. Some believe that papilloma- 
Ps tous tumors are contagious. Mégnin described alleged in- 
| - fectious papillomata on the lips of lambs in which he demon- 
‘strated spherical pathological microorganisms. M’ Fadyean 
ie and Hobday have successfully transmitted papillomata from 
one dog to another. Aubert and others have observed 
_ transmissjon from cows to men. The inoculation experiments 
of Gratia, on the other hand, were unsuccessful. 

ei in midition to the irritation theory, the question of 
heredity as an etiological factor in the production of papil- 
mata must be considered. It has been observed that in foals, 
‘alves, and dogs, papillomata are congenital. Many believe 
; hereditary transmission. In these cases inflammation is 
~ excluded as an etiological factor; the basis of the cause must 


c OccURRENCE.—Papillomata are most often found in 
rs, horses, and cattle. 

In dogs, the favorite locations for develop- 
t are the lips, the mucous membranes of the mouth (lips, 


au i Sanat: tie buccal forint prepuce penis, the anus and 
| pvagina, as well as the extremities. Papillomata are 

"characterized by their rough and lobulated surface; they 
similar in RSI EAS to strawberries, rasp- 


146 PAPILLOMA 


berries, blackberries, cauliflower, cockscomb, 
etc. They usually havea sharply defined margin, occasionally 
they are pedunculated ; they vary in size from a lentil-seed to 
that ofa pea ora walnut; they may be dry or moist on the 
surface. General papillomatosis is common. 

2. In cattle papillomata are often multiple so that 
the entire skin appears to be covered with warts. They are 
especially numerous on the head, throat, on the shoulders, 
udder, abdomen, on the penis, and on the limbs. They form 
rough, granulation-like, lobulated, painless neoplasms; they 
are often fissured, and are broad or pedunculated; they are 
firm in consistence, and yellowish-white in color, they become 
confluent and attain the size of a man’s fist, sometimes even 
that of a man’s head. Papillomata are extremely variable in 
form ; at times they lead to an extensive thickening of the skin, 
and they may attain a weight of fifty punds. Thierfelder 
observed a papillomatous tumor that extended from the withers 
to the root of the tail in a three-year-old heifer; it was from 
30 to 40 centimeters broad and 15 to 20 centimeters thick ; 
from a distance it had the appearance of the horny covering of 
an immense tortoise; nearby it was similar in appearance to 
the quills of a porcupine. Wehrner has described a case 
of papillomatosis with a mane-like covering of hair (hypertri- 
chosis) on the neck. In many cases the udder is the seat of 
numerous papillomata ; the dry form is especially common on 
the teats, occasionally the teats are the seat of soft, villiform 
warts. In addition to these cutaneous papillomata, others 
are frequently observed on the mucous membrane of the 
pharynx and esophagus, occasionally they are seen 
in the omentum and bladder. In lambs, warts are 
very often found on the lips. 

3. In the horse, especially in foals, warty growths 
are found in the region of the lips, the nose, on the eye-lids, 
ears, on the sheath, etc. In older horses they are found on 
the following places: in the region of the saddle and 
- harness, on the coronet (personal observations), as well 
as subsequent to scratches on the fetlock (dermatitis 
verrucosa so-called ‘‘Straubfuss’’ bristle-foot). They are 


a 


ADENOMA 147 


very rarein the bladder where they form one variety of so- 
called villiform cancer. Canker of the hoof (canker 
of the frog) isa papillomatous neoplasm ; it is characterized 
by pronounced proliferation of the papillary body and rete 
mucosum ; inthisdisease the growth of the horn is suspended 
(infection ?). 

TREATMENT.—Treatment of papillomata consists in sim- 
ply cutting away with scissors, or twisting off with 
the fingers. Caustics (concentrated nitric acid and other 
acids) are not indicated, with the exception of papillomatosis 
of the frog; in any case they should be applied with great 
caution in the vicinity of the eyes and mouth. Papillomata 
on the lids, because of the possibility of transformation, must 
be thoroughly treated, that is, extirpate the entire tumor by 
removing a keel-shaped section of the lid. In young animals, 
the internal administration of arsenic has occasionally been 
followed by good results. Papillomata often disappear with- 
out treatment. Spontaneous healing of cancer of the frog has 
occasionally been observed after recovery from contagious 
pleuropneumonia. 


III, ADENOMA. 


NaAtTurRE.—An adenoma is a non-cancerous, be- 
mien, epithelial neoplasm of glandular type. 
Adenomataaretermed tubular, acinous, or alveolar, 
according tothe type of the gland from which they are de- 
rived ; they are also classified according to the nature of the 
‘gland, adenoma of the thyroid gland (struma), 
Mammary, hepatic, sudoriferousand sebaceous 
adenomata. When an adenoma consists largely of con- 
nective tissue it is termed a fibroadenoma; when the 
converse is true it is termed an adenofibroma (so-called 
fibroepithelial neoplasms). Adenomata, regardless 
of their benignity as epithelial neoplasms, occasionally have a 
tendency towards carcinomatous transformation (malignant 
adenoma, adenoid). 

OccURRENCE.—It is most frequently seen, especially in 


148 EPITHELIOMA 


puppies, in the form of goitre (simple hyperplastic struma)— 
adenoma of the thyroid glands—it is less common in the horse 
(Lanzillotti, Markus, Pfeiffer, personal observa- 
tions). Adenofibromataofthenasal mucous mem- 
branes are relatively frequent in horses (firm, rough, mul- 
tiple, readily hemorrhagic, usually bilateral neoplasms on the 
lower third of the nasal mucous membranes ; formerly they 
were erroneously termed rhinoschleroma). Adenomata are 
not rare in the mammae of the bitch. Only a portion 
of these neoplasms, however, are pure adenomata, they are fre- 
quently fibroadenomata, adenofibromata and myxoadenomata ~ 
(Leblanc). An adenoma of the mucous membranes of the 
larynx has been observed ina cow by Johne; sebaceous 
adenomata and sudoriferous adenomata have been observed in 
the skin of dogs, especially in the vicinity of the anus (perineal 
glands) (Kitt, Siedamgrotzky, Moller, and others). 
Adenomata of the Harderian glands of the membrana 
nictatans have been observed in the dog by Schimmel and 
myself. Adenomata also occur in the rectal mucous 
membranes (glands of Lieberkuhn) of horses in the form 
of cysts and polypi (personal observations). Adenomata of the 
liver, as well as of other inner organs, are of no surgical 
importapce. 

EPITHELIOMA.—In Germany this term is applied to a benign, 
circumscribed neoplasm of the epidermis on the skin 
(in France, epithelioma indicates a carcinoma). It is partly due to con- 
tinual irritation of the skin by pressure (callosities, clavyus, 
tyloma), partly caused by parasitic infection (e pithelioma gre- 
garinosum or molluscum, bird-pox). 

CorNU CUTANEUM.—This is an epithelial neoplasm similar to 
epithelioma (cornu cutaneum, keratosis, keratoma). It is 
a circumscribed outgrowth of newly-formed, horny, epidermal cells. 
They are often fourid in cattle on the neck, in the intermaxillary space, 
on the head, on the abdomen and udder; occasionally they occurin the 
form of horn-like structures one-fourth to one-half meterin length; at 
times they are of actinomycotic origin (Schreiber); they may also 
occur in birds asa symptom of tuberculosis of the skin (Kberlein 
has described a typical case in a parrot), they are found in horses (fet- 
lock, ear), sheep, dogs, and goats.—KERATOMATA (tumor-like, usually, 
however, inflammatory hyperplasias of the hoof-horn) are similar pro- 
liferations; the same is true of onychoma (hypertrophy of the © 


CYSTIC TUMORS 149 


- 


SS issue of the nail), ichthyosis (congenital or horn-like thickening 
of the entire skin, especially in calves), as well as hystriciasis 
- (congenital bristle-like erection of the hair and thickening of the skin). 


_—s«s GCvrroma'ra.—These are epithelial neoplasms in glands, 
a 


\ 7 mata. They are most often found in the ovaries (ovarian cysts), in the 
a gland (cystic goitre), in the mamme, parotid, and in the supe- 
ae maxilla of the horse. In contrast to ordinary cysts, cystomata are 
; eat Eeeerine, proliferating cysts (see page 150). 


Oe Cyst Ce PUMORS, 


DEFINITION.— A cyst isa sac-like, spherical, or bladder- 
like tumor ; it contains fluid and is surrounded by a capsule. 
Bote development of cysts is extremely variable. The following 
forms are recognized. 

Retention-cysts. 

Dermoid cysts. 

. Genuine cysts (cystoma). 
Hxtravasation-andexudation-cysts. 

Pte ystic degeneration. 

RETENTION-CysT.—A retention-cystis formed by a re- 
eS “tention of thersecretions of a’ gland.. Various 
ae types of retention-cysts are recognized. 

——— a)—«SCSo-ealled mucous cysts develop from the mucous 
membranes as a result of retention of the secretions of the 
mucous glands. They are especially common in the oral cav- 
ties of dogs, cattle, and horses; they are situated at the 
ateral and ventral surfaces of the tongue in the form of so- 
called ranulae (retention-cyst of the sub-lingual gland ; 
em, ete to others a dermoid cyst); in the intermaxil- 


hb e lips, especially on the upper lip in the horse; 
nthe nasal cavities; at the base of the epiglottis; 
and i in the trachea of horses and cattle. They are found in 


with cystic formation. They may be defined as cystic adeno- 


0-called meliceris; on the mucous membranes of 


150 DERMOID CYSTS 


as well asinthe rectum in horses (glands of Lieberkuhn). 

b) So-called atheromata (pultaceouscysts, encysted 
tumors) occur in the skin, especially that of horses (base of 
the false nostril, inner canthus of the eye, base of the auricu- 
lar cartilage), swine (teats), and dogs (back); they are 
usually solitary. Multiple atheromata are rare (Velmelage 
has described a case in the dog). Formerly they were all con- 
sidered retention-cysts of the sebaceous glands. Recent investi- 
gations have demonstrated that they are partly due to aberra- 
tion of epidermal cells, such cases must be classified with. 
dermoid cysts. 

c) Retention-cysts of large glands, especially the 
udders of milch cows are due to an obliteration of an individual 
milk-duct, or the common milk-canal. 

DERMOID CystTs.—This name indicates neoplasms whieh 
belong to the teratomata. They are due to an embry- 
onic wandering of germ-cells of )§ ieee 
or mucous membranes; these may pass into the 
inner organs (subcutis, ovaries, testicles, brain), so that, 
under certain conditions, the walls of the cyst contain all the 
different elements of the skin or mucous membrane, namely, 
epidermis, papillary body, hair and feathers, sebaceous, sudo- 
riferous, and mucous glands. To this class belong the so- 
called tooth-follicle cysts; these occur in horses and 
cattle in the vicinity of the parotid glands(so-called ear-fistula ) ;. 
they are branchial-arch teratomata, that is, derivatives of a 
primative tooth-fold of the epithelium of the oral cavity, they 
are a result of the presence of the branchial arches. One 
usually finds a small opening at the base of the ear, the sur- 
rounding hairs are matted by a tenacious, slimy fluid; on 
passing a probe it enters a blind canal or cystic hollow space, 
at the bottom of which a molar tooth is found. About one 
hundred cases of branchial-arch teratomata in horses and cattle 
have been recorded. Dermoid cysts also include the very rare 
tooth-teratomata onthe superior and inferior maxilla 
of the horse; these are large tumors which contain hundreds 
of teeth in all stages of development (Ostertag, Lohoof). 
By many, ranula isconsidered a dermoid cyst. Dermoid 
cysts of the ovaries are very rare (hair, teeth, bones). 


i 
a 


> 


EXTRAVASATION- AND EXUDATION-CYSTS I5!1 


GENUINE Cysts.—Genuine cysts are also termed cy sto- 
mata; they areglandular, epithelial neoplasms 
(cystoadenoma) (see page 148). They are most often found 
imjthe Ovaries andinthe thyroid glands. ‘They are 
the ordinary cystic formation (single sac, or multiple hollow 
spaces) in the ovaries of cattle, horses, and dogs; occasionally 
they become very large. Stockfleth has observed a 
cystic ovary that weighed 125 pounds, inacow; Albrecht 
has observed one that weighed 80, and another that weighed 
50 pounds in the horse. I observed a case in which a cystic 
ovary as large.as a child’s head constricted the rectum and 
caused fatal colicin a mare. Finally, genuine cysts occur in 
the superior maxilla ofthe horse (detached epithelial 
foci) ; occasionally they press through the superior maxillary 
sinuses into the nasal cavity (pseudo-hydrops of the maxillary 
sinus). 

EXTRAVASATION- AND EH}XUDATION-Cysts.—Hematomata 
due to contusions may become encapsuled as a result of aseptic 
inflammatory processes in their vicinity ; they form swellings 
having a cavity filled with serum, and are termed extrava- 
sation-cysts or blood-cysts. They are frequently 
observed on the anterior surface of the carpal-joint in cattle 
(so-called knee-boils), and on the neck and back of the dog. 
Their existence is analogous to capsule formation around for- 
eign bodies and parasites (foreign-body cysts, parasitic cysts). 
Blood- and lymph-cysts, the result of gradual dilitation of 
blood- and lymph-vessels (dilitation-cysts), are less common. 
Hxudation-cysts are formed in a similar manner asa 
result of inflammation of mucous membranes and tendon- 
sheaths. To this class belong hygromata of the mucous bursae 
over the point of the elbow (so called shoe-boil) and os calcis 
(so-called capped-hock ) in horses and dogs, as well as hygroma 
proliferum on the carpus of the horse and ox (one form of 
knee-boil). 

DEGENERATED Cysts.—These are cystic degener- 
ated neoplasms (cystoid degenerations); they most often 
occur in sarcomata and in carcinomata (cystosarcoma, cysto- 
carcinoma, cystofibroma). 


152 ACTIONOMYCOMA 


TREATMENT.—Treatment of cysts consists in extirpa- 
tion of the sac. Simple puncture or incisions 
usually insufficient ; this is especially true of mucous cysts 
and atheromata. On the other hand, puncture with a subse- 
quent injection of tincture of iodine is effectual in many 
forms of extravasation- and exudation-cysts (hygroma, shoe- 
boil); it is necessary to incise and remove the necrotic sac. 
When removing the sac care should be taken to remove all the 
parts; no portion of the proliferating tissue should remain 
behind. Special difficulty is encountered in the total extirpa- 
tion of ranula ; this is also true of many mucous cysts in the 
throat of the dog. On the other hand, teratomata are usually 
operated without difficulty. In tooth-follicle cysts the teeth 
are removed from the temporal bone with hammer and chisel, 
and the mucous membrane of the cystic sac is carefully curetted. 
Cysts of the ovaries in cattle may be crushed per rectum with 
the hand. | 


D. INFECTIOUS TUMORS. 
I. ACTINOMYCOMA. 


ETIOLOGY AND PATHOGENESIS.—Actinomycoma is a 
swelling caused by the ray-fungus or actinomyces. This 
fungus, which belongs to the schizomycetes (cladothrix), was — 
described by Perroncito, Rivolta, Hahn, and Bol 
linger in the years 1868-1877. Macroscopically it forms 
sulphur-yellow, sand-like kernels. Under the microscope 
they have the appearance of glands, with a branching, rosette- 
like arrangement, composed of club-shaped, thick threads. 
Entrance of the actinomyces fungus into the 
body seems to occur in various ways. It usually gains en- 
trance through the digestive tract (mouth cavity, 
pharynx, stomach, intestines). Their primary seat is on the 
fragments of plants; they have been especially demonstrated 
on beards of grain, in the tonsils of swine, and in the 
tongues of cattle. It is thought that transmission occurs as 


ACTIONOMYCOMA 153 


a: ; | 
q a follows : at first the fungus gains entrance to small wounds of 
the mucous membranes, or passes into the excretory ducts of 
glands, possibly it colonizes in the alveoli of diseased teeth, or 
those that are changing: its further extension is from these 
memis. In cattle, espectally, beards of grain 
meovered with fungi appear to penetrate bie- 
tweentheteeth and gums, as wellasintothe 

_ tongue. When they once gain entrance removal is difficult 
because of the peculiar arrangement of the hairs on the beards ; 
 asimilar phenomenon is observed with rye-beards, for example, 
_ when they become attached to one’s coat-sleeve. A favorite lo- 
ation for actinomycosis of the tongue is on the dorsal 
surface where it begins to form the point. Epithelial 
_ defects are present at this point in many cattle (9 percent), 
‘thus favoring the introduction of an actinomycotic infection 
(Hentschel and Falk). According to Breuer the 


- foldsof the dorsal surface, especially in old ¢attle, where 
they are well developed, predispose to the retention of 


_fungus-covered vegetable fibers. Bostrom thought that the 
| ray-fungus developed exclusively on grain, especially in barley, 
and that actinomycosis could be caused only by ingestion of 
portions of these infected plants. Symmetrically arranged air- 
_ spaces are found in dry grain-beards, these communicate 
_ freely with the surface; within these spaces the fungus is 
- able to live in a dried condition for more than a year; when 
ze the beards gain entrance to animal tissue proliferation is again 
active. Dry fodder, therefore, appears to be the principal 
_ source of infection in cattle; perhaps simultaneous shedding 
Woof the teeth also has an influence (Immiger, Claus). 

_ Entrance to the lungs may take place by aspiration of the 
fungus from the air; wounds of the skin, especially 
castration wounds and umbilical wounds 
_ allow entrance; it may also enter through the open- 
a “ings in the Hes In swine, infection of the snout from 
hI the straw seems to be frequent. In a large number of cattle 
+ treated with setons a majority of the wounds showed actino- 
__- mycotic infection (Gooch). General extension (general- 
oy ey iza tion) over the entire body by means of the blood- stream 


ioe es hs wo). es ee eee 
es peed area oT a ‘ 
‘ ’ F 7) j 


154 ACTINOMYCOMA 


also occurs, similar to tuberculosis, though far less frequently. 
With reference to the rapidity of growth of actinomycoma, the 
following observation has been made by Anderson: 
twenty cows were turned to pasture on the first of July ; small 
_and large tumors had developed on seventeen by the first of 
December (five months). 


Actinomycosisisa specific inflammation; domes- 
tic animals are affected with three grades of the disease: 1. 
A degenerative granulo-fibrous inflammation (tongue). 
2. A progressive purulo-granular inflammation (cold 
abscess). 3. Fungoid actinomycoma (pharynx, skin). In 
the vicinity of glands in which the fungus is active, there first 
develops a granulation-like growth, the result of a 
reactive inflammatory process. This leads to the formation of 
tubercle-like nodules, larger round or lobulated swellings, and 
tumors, which are termed actinomycomata. Sometimes 
they are very soft, of a sarcomatous consistence, and yellow- 
ish-red in color; others are apparently firm and solid, of the 
consistence of a fibroma, and greyish-white in color ; occasion- 
ally they are spongy. They consist of a connective-tissue 
stroma permeated with many nodules the size of a millet-seed 
to that of a pea; on the surface of the swelling these nodules 
present ashiny appearance. The nodules have the microscopic 
structure of a granuloma (round-celled infiltration with the 
formation of giant-cells), they contain the sulphur-yellow, 
sand-like actinomyces fungi, they may also become confluent 
and form larger nodules. In purulent degeneration of actino- 
omycoma (mixed infection with pus-bacteria) so-called cold 
abscesses are formed, these may be small or large and are 
surrounded by very soft granulation-tissue. 


BACTERIOLOGY.—According to Bostrém, pure cultures of actin- 
omyces are best obtained by pulverization of the gland, and cultivation 
upon coagulated blood-serum. ‘They present the following character- 
istics: first there are developed thin, gelatinous membranes, they are 
formed of fine, transparent threads, and through a deposit of small white 
particles containing numberless cocci and fibrille they assume an appear- 
ance of having been dusted with chalk. After two weeks the 
centers of the white particles become yellowish, red, or brick- 
red, the particles themselves become confluent; the periphery grows 


ACTINOMYCOMA \ 155 


in the form of a transparent greyish-white layer. Old cultures become 
wrinkled and hard. The fungus grows in a similar manner on agar» 
glycerin-agar, and gelatine ; on potatoes it forms grey, yellowish, and 
finally white granules. It also grows in the absence of air (facultative 
anzerobic fungi). Inoculation of the cultures into animals is not usually 
followed by results. Wolff, Israél, and Johne are the only ones 
that have developed inoculation-actinomycosis from cultures. 

According to recent investigations actinomycosis occurs in several 
varieties in both men and animals. Gasperini was the first to demon- 
strate that actinomycosis in cattle could be produced by various varie- 
ties of the fungus (sulfurens, albus, luteo-roseus). According to Lig- 
niéres and Spitz in Argentina there occurs an actinobacillosis 
in addition to genuine actinomycosis. The bacillus does not take 
Gram’s stain; clinically it is characterized by disease of the 
lymph-glands (which is seldom seen in the genuine form), anda grayish- 
white color of the glands (in contrast to the yellow). Jelenewski 
has discovered a specific ‘‘Actinomyces labiatus bovis’’ in actinomycoma 
of the lips.. Levy, Bruns, and others have further claimed that 
several varieties occur in man (zerobic and anzerobic), and that actin- 
omyces bovis and hominis, especially,are not identical. 
According to Wolff and Israél, however, the acceptance of various 
ray-fungi is incorrect; they explain the difference in size, etc., by 
variations in age, and the duration of the disease. 


OcCURRENCE.—One most frequently finds actinomycoma 
in cattle in the mucous membranes of the mouth 
Seemed yl xX, oi the tongtre, in the maxillary 
bones, in theskin, in the parotid glands, and in 
the udder. Occasionally actinomycosis appears in a gen- 
eralized form. The disease is most frequent in cattle ; 
horses, swine, and sheep are occasionally affected; it is less 
frequent in cats and dogs. 


ACTINOMYCOMA OF THE TONGUE.—In the tongue acti- 
-nomycosis is usually multiple and disseminated ; connective- 
tissue proliferation is abundant (indurative, and acti- 
momeycotic glossitis, actinomycotice schlero- 
sisormacroglossia, so-called wooden-tongue). 
The tongue is very much enlarged and deformed, occasionally 
it is shapelessly swollen, and of a very firm, hard consistence. 
On the mucous membranes of the inferior and lateral surfaces 
one observes sharply circumscribed, somewhat 
prominent brownish spots, spherical in form; 


156 ACTINOMYCOMA 


through these there shine very small yellow- 
ish nodules. Actinomycotic nodules are also 
present in great numbers within and beneath the 
mucous membranes, as well as between the 
muscular fibers, they are firm, fibrous, roumoe 
ish nodules, and vary in size from 4 stipe 
seed to that ofa pea; in the center they consist of a suppura- 
tive, caseous, calcified, or mortar-like mass. When cut the in- 
durated connective tissue of the tongue is found to be lardaceous, 
hard, and even crepitating. The lymph-glands of the 
tongue also contain the above described nodules, as well as 
abscesses in the form of yellow, sand-like, antinomycotic foci 
containing pus. Actinomycotic erosions are also occa- 
sionally found on the dorsal surface of the tongue, they form 
epithelial defects where the body of the tongue passes over 
into the point. Brownish actinomycotic nodules occur on the 
gingivae as well as on the inner surface of the lips 
(Klepzow). On the ventral surface of the oral cavity actin- 
omycotic proliferations of the mucous membranes occasionally 
present the appearance of a ranula (Hohenleiter). A 
few cases of actinomycosis of the tongue have been observed 
in the ,horse (Truelsen, Gruber, ZScChgageae 
Novotny, Struve, and others). Schilling has de- 
scribed one case in swine. 

ACTINOMYCOSIS OF THE MAXILLARY BONES.—A ctin- 
omycotic ostitis of the superior and inferior maxille 
was formerly known as ‘‘winddorn’’ ‘“‘spina ventosa,”’ 
‘‘bone-worm,’’ ‘‘maxillary tumor.’’ It arises from superficial 
granulations on the gums and mucous membranes in the 
vicinity of the teeth. At first there exists an actinomycotic 
periostitis ossificans with the formation of osteo- 
phytes. If the actinomycoma also involves the bone-marrow, 
there develops an actinomycotic granular osteomye- 
litisand rarefying ostitis (myelogenic actinomycosis), 
with atrophy of the osseous framework and the formation of 
great hollowcavities. Both processes leadto. severe swell- 


ing of the superior and inferior maxillae. 
Frequently the actinomycotic granulation-tissue assumes the 


ACTINOMYCOMA | : pee eae 

form of a sarcomatous proliferation ; it may then pass in the 
direction of the gums, the molar teeth, the skin, as well as 
into the maxillary and frontal sinuses. In the horse central 
actinomycoma occursin the inferior maxilla with loosening of 

theteeth. The disease also occurs in the form of an epulis-like 
extensive actinomycoma of the dental alveoli in the inferior 
and superior maxille (Pilz, Geiger, Schwarz, and 
others). Central, myelogenous actinomycoma is also ob- 
served in other bones: in the sterum, in the dorsal 
vertebrae, cervical vertebrae (spinal pressure- 
paralysis in the cow), in the ribs, in the tibia, in the 
metatarsus (lameness). 

ACTINOMYCOMA OF THE PHARYNGEAL CAvity.—In this 
place it forms fungus-like, polypoid, soft tuber- 
cles or nodules; they are attached by short 
Beeaicles, and vaty in size froma pea to that of 
one’s fist. They usually proliferate from the pharyngeal 
mucous membranes on the superior wall beneath the sphenoid 
bone (anterior pharyngeal actinomycoma), they may arise 
from the posterior wall of the pharynx in the vicinity of the ep- 
iglottis (posterior pharyngeal actinomycoma). They may 
lead to dyspnea or asphyxia. Formerly they were termed 
“pharyngeal Imyphomata’’ or ‘‘esophageal fibromata.’’ Simi- 
_ __larnoduies are found on the mucous membranes of the eso ph- 
. emacs, ithe larynx, in the trachea, and on the mu- 
iia cous membranes of the trachea, nose, and vagina, 
if 4 as well as on the mucous membranes of the digestive appa- 
Meeeetatus. In Russia actinomycoma of the lips is es- 
pecially frequent (more than 4o to 80 per cent of all cases) 

(jJelenewski). 

Ae LYMPH-GLAND ACTINOMyCcoMA.-—This is a secondary, 

___ metastatic process, a sequela of primary affection of the oral and 
pharyngeal cavities. The subparotid and intermax- 
illary lymph-glands are most often affected in the form 
__ of round or oval, firm nodules ; they are painless and vary in 
| Be size from a walnut to that of one’s fist. In horses these actin- 
_--—s OmMycomata occur in the intermaxillary lymph-glands where 
ey, “adh _ they attain the size ofa hen’s egg or goose-egg; when unilateral 


i es 

Se 

a 
> 


mht 


158 ACTINOMYCOMA 


they give rise to suspicion of glanders (Baranski, Pilz, 
Rasmussen, Schmidt, Hartl). In a case described 
by Schmidt all the lymph-glands of the head and neck, as 
well as the bronchial glands, were swollen as large as a fist 
and permeated with actinomycotic foci. In a case of suspected — 
glanders in the horse Hartl found the entire intermaxillary 
region filled with a firm, flat swelling, it even extended to the 
cheeks ; a finger-thick lymph-vessel cord extended to the 
angle of the mouth, hard nodules were present at intervals 
along the cord, they were from the size of a nut to that of an. 
egg; hard nodules the size of a bean were also found in the 
upper lips and in the region of the parotid. Microscopic ex- 
amination of the extirpated gland revealed masses of ray-fungi. 
The salivary glands are also occasionally affected. 
ACTINOMYCOMA OF THE SKIN AND SUBCUTEM.—These 
are primary (infection through a skin-wound) and secondary 
(outward penetration of deep foci), on the head, neck, ud- 
der, scrotum, in the region of the elbowand shoulder, as well 
as on the abdominal wall. They either form nodules from the 
size of a hazel-nut to that of one’s fist, or fungoid, fleshy- 
red, soft granulation masses; the latter are either covered with 
pus, or with dry brownish crusts. Occasionally the adjacent 


skin undergoes an extensive phlegmonous swelling and schler- 


osis. Daughter-nodules frequently form in the vicinity of an 
old focus. Keratogenous formations are less common (Schret- 
ber). Subcutaneous actinomycoma is accompanied by the 
presence of fistulous openings. In a case described by Hart] 
a horse suspected of having glanders presented the following 
symptoms: subcutaneous swellings in the flank and on the 
ventral surface of the abdomen; these areas were covered 
with ulcer formations, abscesses and sanguino-purulent secre- 
tions ; numerous actinomyces fungi were found in the indurated 
abdominal muscles. Meier observed actinomycotic cutaneous 
nodules as large asa hazel-nut in the saddle region of a horse. 
Occasionally actinomycotic proliferations are observed on the 
anterior surface of the carpal-joint in cattle (one form of so- 
called knee tumor in working oxen). Actinomycoma has also 
been found in castration wounds of both male and 


ACTINOMYCOMA 159 


female pigs, as well as inthe spermatic cord of castrated 
horses and cattle (Rasmussen, Mazzarella). Accord- 
ing to Burke the so-called Madura-foot of elephants is an 
actinomycosis of the skin. 

ACTINYOMCOSIS OF THE UDDER.—This form is most often 
seen in Swine, it is also observed in cows. In the udders 
of swine one finds numerous nodules, they are imbedded in a 
firm, fibrous tissue ; in size they vary from a pea to that of a 
walnut ; they may contain pus, or form large abscesses which 
occasionally break through the skin. In cattle one observes 
soft purulent nodules with fibrous induration 
of the surrounding tissue; they vary in size from a 


_pea to that of a goose-egg, they may be confined to one or 


more quarters, and occasionally they break through the skin 
forming ulcers and fistulous tracts. Disseminated actinomy- 
cosis of the udder is less common, in this case the entire udder is 
severely swollen, and becomes hard and rough ; the cut surface 
reveals numberless soft yellow flecks which vary in size 
from,a millet to a hemp-seed, they contain small purulent foci 
in reddish nodules (Bang, Jensen, Rasmussen, Kitt). 

_ Actinomycosis of the muscles is of secondary origin 
from penetrating cutaneous actinomycoma; Rassmussen 
has described one case of actinomycotic disease of the muscles 


of the elbow and shoulder. Gorig has observed a case of 


actinomycosis of the testicles in a bull, which developed after 
an injury to the scrotum. In dogs, local actinomycotic affec- 
tions (tumors, abscesses, fistulee) often accompany pleuritis 
and peritonitis (Bahr). Actinomycoma of the internal or- 
Pens (lunes, liver, spleen, kidneys, brain, dia- 
phragm, uterus, bladder) is of no surgical importance. 

. TREATMENT.—Where operation is possible, extirpa- 
tion with the knife is the best treatment, the same as in 
other tumors. Actinomycoma of the tongue, as well as 
deeply situated actinomycoma of the pharynx responds to the 
external or internal administration of iodine, which is con- 
sidered a specific for the disease. The action of iodine seems 
to be directed to the tissues which surround the growth, as 
actinomyces fungi flourish on media containing iodine. Ex- 


160 ACTINOMYCOMA 


ternally, iodine is administered in the form of tincture of 
iodine, or as Lugol’s solution. The former may be painted 
on the surface of the tongue, while Lugol’s solution may be 
employed in the form of parenchymatous injections into the 
tissues of the tongue ; many scarify the tongue and then paint 
with iodine solutions. For tumors that cannot be operated 
iodid of potash administered internally is also alleged 
to be a specific remedy. 

According to Thomassen who, in 1885, was the first 
to recommend the internal treatment with iodine, the following 
results were obtained : for fourteen days the cattle were given 
daily doses of six grams of iodid of potash dissolved in one- 
half liter of water ; with a beginning of improvement the dose 
was reduced to four or five grams. When the disease was 
confined to the tongue and surrounding soft tissues, healing 
averaged to occur at the end of fourteen days, improve- 
ment was visible at the end of eight days. Numerous 
demonstrations ofthe specific action of iodid of potash 
have been made. (Furthmeyer, Bass, de jiu 
Ostertag, Deslex, Reeks, Perinni, Havasjeeueee 
cail, Hohenleitner, Krug, Nocard, Schwagems 
Walther, Ehrhardt, Salmon, Bang, Jensen, and 
others). In many cases iodid of potash is ineffective 
(Immiger, Frick, Bouchet, andothers), Bouchet, 
for example, treated a horse an entire year with iodid of potash 
(1500 gramsinall) without results. In addition to the internal 
administration of iodid of potash, it may be employed exter- 
nally in the form of tincture of iodine, or Lugol’s solution, 
either in the form of painting on the surface, or parénchyma- 
tous injections. The fact should not be overlooked, that 
spontaneous reduction of actinomycoma, without previous 
treatment, has occasionally been observed. Under certain 
conditions, mere incision of the actinomycoya appears to be 
followed by healing. Bossi has observed complete healing 
in two cases of actinomycosis of the tongue in cattle that were 
treated as follows: simple deep incisions of the tongue re- 
peated three times at intervals of ten days, 


BOTRYOMYCOMA 161% 
II. BOTRYOMYCOMA. 


ErT1ioLoGy.—The name botryomycoma or myco- 
fibroma indicates a chronic inflammatory proliferation of 
the connective tissue ; itis due to the botryomycesfun- 
gus that was discovered in 1884 (botryococcus, micro- 
coccus ascoformans, micrococcus botryogenus). Itisa fungus 
feemed Of roundish cocci arranged in black- 
berry-like clumps; it has received special investigation 
from Rivolta, Johne, Rabe, Bollinger, Jensen, 
Seeeiteli, dejong, Poncet and Dor, Parascan- 
dolo, and others. Botryomycoma is a neoplasm that very 
frequently occurs inthe horse. Because of its size and ma- 
lignancy it possesses as great surgical importance as actinomy- 
cosis in cattle. I have, for example, operated not less than 
400 cases in the years 1895-1903 in a surgical clinic of 8000 
diseased horses. These included 175 shoulder tumors, 150 
fistulz of the spermatic cord, and 75 other forms of botryomy- 
coma. Botryomycosis, similar to actinomycosis, may be con- 
sidered a wound infection disease in which the botryomyces 
fungus gains entrance through small wounds in the skin, es- 
pecially operation wounds (castration). Generalization is far 
less common than in actinomycosis. Botryomycomata that are 
very important from a surgical standpoint are most often found 
in the following places: botryomycoma of the skin and 
subcutem, of the spermatic cord, of the udder, 
of the nasal mucous membranes, and inthe mus- 
cles, itis less commonin bones. In addition to occurrence 
in horses, botryomycoma has occasionally been observed in 
cattle and swine, as well as recently in man. 


BACTERIOLOGY.—Formerly the botryomyces fungus was considered 
identical with ordinary pus-cocci, staphyloccus pyogenus aureus (Hell, 
de Jong, Galli-Valerio, Kitt). According to recent investiga- 
tions of Parascandolo, and Poncet and Dor, the specificity 
of the botryomyces fungus seems to be demonstrated. The inoculation- 
experiments in horses, as well as the various bacteriological, physio- 
logical, biological, and sero-diagnostic relations of both organisms 
supply evidence against their identity. The botryomyces organ- 
ism can even possess pyogenic properties—ability to 


162 . BOTRYOMYCOMA 


produce mycofibromata—that are never possessed by 
the staphylococcus. The staphylococcus forms goldish-yellow 
cultures in any temperature; the botryomyces organism, however, 
develops cultures only at a temperature of 18°. Bacteriologically they 
are alike in form; they take the same stain with aniline dyes; and their 
grape-like arrangement in clusters is the same. Their development on 
gelatine is not the same, their properties of immunization are also very 
different. The pyogenic—not, however, the botryogenic—properties 
are identical, 


BOTRYOMYCOMA OF THE SKIN.—This occurs in the form 
of tumors that are partly solitary, partly multiple, and occa- 
sionally scattered over the entire skin. It most often develops 
inthe saddle and harness regions, on theel bows, 
tail, fetlocks, lips, and eyelids, in the teem 
the parotid, atthe tarsal-joint and scrotum. Their 
size is extremely variable ; very often they are only the size of 
a pea tothat of one’s fist, occasionally, however, they assume 
an enormousextension becoming larger than any other 
tumor. At the elbow, in the region of the shoulder, as well 
as at the fetlock, tumors have been repeatedly found that were 
as large and larger than a man’s head. Occasionally many 
small nodules are arranged around a primary large nodule. 
Their consistence is usually firm, at other times they are soft, 
and may even show circumscribed areas of fluctuation; occa- 
sionally fistulous tracts lead into the substance of the tumor. 
On the cut surface one finds sand-like deposits of botryomyces 
fungi, as well as areas of liquefaction containing torpid gran- 
ulation-tissue and small pus-cavities ; the latter are enclosed in 
a tendinous, firm, schlerotic connective-tissue proliferation. 
Large tumors proliferate from the skin into the subeutem and 
into the organs that are more deeply situated. I observed one 


case of actinomycoma on the back in the form of a fistula 


of the withers. : 
BOTRYOMYCOSIS OF THE SPERMATIC CORD.—Most cases 
of so-called fistula of the spermatic cord in the 
horse are to be regarded as funiculitis botryomycotica, specifi- 
cally, as botryomycoma of the spermatic cord. Infection of 
the castration wound takes place through the dust. The 
stump of the spermatic cord begins to proliferate; the tunica 


oe 


ee, 


BOTRYOMYCOMA 163 


vaginalis undergoes a chronic induration, and adhesion takes 
place between the two. They forma hard tumor that 
merres in size from a man’s fist tothat ofa 
man’s head; in form itis shaped likea walnut. 
The tumor may extend to the inguinal canal; occasionally it 
presents fungoid proliferations between the margins of the 
wound (so-called champignon); it frequently encloses 
one or more fistulous tracts, the latter open below in one or more 
funnel-like, constricted, fistulous openings. The 
fistulous openings discharge a purulent mass containing botry- 
omyces fungi. In many cases the botryomycoma extends 
from the spermatic cord to the sheath, the adjacent skin of the 
limbs, and the ventral surface of the abdomen, so that there is 
formed an enormous tumor several times the size of a man’s 
head. Bilateral fistula of the spermatic cord iscommon. In 
extirpated preparations one notes the fatty, firm, ten- 
dinous, light-grey, cut surface; on this surface are 
yellowish-brown, forpid, *muco-purnlent 
areas of liquefaction; these areas contain the yel- 
Bewiyei-white, sand-like botryomyces colo- 
nies, they may be seen with the naked eye. 

BOTRYOMYCOSIS OF THE UDDER.—This form is common 
inthe mare (Moller,~Sand, Vennerholm, personal 
observations). The udder is swollen, hard, shows 
nodular induration, and fistulous openings, 
as well as circumscribed abscess formation. 
Typical botryomyces colonies may be recognized in the pus of 
the fistulous tracts. According to my experience botryomy- 
coma of the udder isa very malignant tumor. Operative re- 
moval is liable to be followed by recurrence; for this reason 
total amputation of the udder is recommended when the dis- 
ease is confined to one half of the udder. They also have a 
strong tendency to extend to the abdominal wall and to the 
inner surface of the limb, extension is apparently rapid. I 
have observed one case of this kind in which one half of the 
udder was amputated two years before and the affection appar- 
ently healed. Unterhossel has described a botryomycotic 
neoplasm that weighed 35 kilograms; it was located on the 
udder of the mare. | 


164 BOTRYOMYCOMA 


BOTRYOMYCOMA OF MuscLE.—Botryomycotic myositis is 
especially common in the levator humeriin the form of so- 
called shoulder abscess; it is also observed in the 
abdominal muscles, the intercostal mega 
andthe lumbar muscles. Botryomycosisof the bones, 
on the other hand, is apparently rare. In the case described 
by Kitt, an adjacent botryomycoma was the cause of a rib 
being transformed into a fungoid, osteoporoticmass. Storch 
has described a botryomycoma that extended frcm the max- 
illary sinus ofa horse; the new-formation arose from the 
mucous membrane, and in two months had reached the size of 
a child’s head ; it caused swelling and asymetry of the maxil- 
lary sinuses and frontal region, as well as dyspnea and unt- 
lateral nasal discharge. 

GENERALIZED BOTRYOMYCOSIS.—In comparison with 
actinomycosis thisis very rare. Inacase of fistulaof the 
spermatic cord of the horse observed by me botryomycotic 
proliferations similar to the nodules of: pearl-disease were 
present inthe lungs. Tempel and Bedel have observed 
similar cases of metastatic formation on the diaphragm and in 
the lungs (a botryomycoma of the uterus was the point of 
origin in the former case). M’Faydean describes three cases 
of generalized botryomycosis in horses affected with fistule of 
the spermatic cord (lungs, spleen). Kitt has observed a very 
interesting case of botryomycotic endocarditis. Hilbrand 
observed a case of botryomycosis of the kidneys (large tumor 
in the vicinity of the right kidney, it was adherent to the colon 
and rectum and filled with abscesses the size of hens’ eggs), 
with numerous botryomycotic abscesses the size of the head of 
a stick-pin in the liver of a horse. Kofler saw a primary 
botryomycosis of the spermatic cord followed by metastases in 
the lungs, in the muscles of the shoulder, the maxillary 
muscles, and the kidneys. Tturnau, when inspecting the 
flesh of a horse affected with fistula of the spermatic cord, 
found metastases in the lungs and liver. 

Primary or secondary (metastatic) botryomycomata in the 
lungs and other inner organs are seldom of surgical impor- 
tance. A transplantation of botryomycoma of the lungs to 


BOTRYOMYCOSES IN MEN 165 


the parietal pleura, and from there to the ribs has occasion- 
ally been observed in cattle; it led to granular ostitis, with 
rarefaction and formation of costal fistule. Babe has described 
a botryomycoma of the pelvic cavity that weighed 15 kilo- 
grams; it was complicated with fistulae having external open- 
ings, as well as openings in the direction of the bladder. 


BOTRYOMYCOSIS IN MEN.—In the past few years several cases have 
been observed in men. Poncet and Dor (Paris Surgical Congress. 
1897) reported four cases; they were in the form of tumors on the 
fingers, the thorax, and the elbows, they presented the following char- 
acteristics : froma pea to that of a nut insize, pedunculated, fungoid, and 
infiltrated with blood. Ten Siethof (Ref. Minch. med Woch. 1898, 
No. 15) saw in a man, who had been caring for a horse 
affected with fistula of the spermatic cord(!), a dis- 
ease of the palpebral conjunctiva that had the appearance of actinomy- 
cosis ; it was accompanied by swelling and nodular formation. Typical 
colonies of botryomycocci were found in the pus of these nodules. 

Other cases have been described by Legrain, Sabrazés, 
Laubié, Délor, Galli, Valerio, and Lenormand. 


TREATMENT.—When possible, botryomycoma receives 
operative treatment, the same as actinomycoma, this should 
be as early as possible, and in the form of extirpation. 
To guard against recurrence the incision should be carried a 
certain distance from the tumor in tissue that is known to be 
normal. Occasionally a botryomycoma is so multiple or so 
large that operative removal at one t¢me is impossible. Such 
cases may be operated at different times. Siedamgrotzky, 
for example, removed a large multiple botryomycoma from 
the skin of a horse during six operations which covered a 
period of three months. I have employed similar partial op- 
erations. There are also cases which, on account of enormous 
size or generalization, cannot be operated. 

Iodid of potash has been employed as a specific for 
botryomycosis, the same as actinomycosis. Thomassen 
gave horses daily doses of 10 grams of iodid of potash, the 
spermatic cord was treated locally with tincture of iodine, after 
a month the tumors were markedly smaller. Siegmund 
gave doses of 12 to 15 grams of iodid of potash three times 
per day, so that the horse had 800 grams in all, 1200 grams 
were given to another; he reported satisfactory results. 


166 TUBERCULOSIS 


Ostertag, Malkmus, and others, report similar results 
from the use of iodid of potash. According to my own 
experience and experiments the bDemeiouas 
action of iodid of potash has not been Sipe 
ported. Ina horse affected with botryomycosis of the sper- 
matic cord, the skin, the abdominal muscles, and the lymph- 
glands, neither the internal administration of 325 grams of 
iodid of potash, nor the subsequent intratracheal injection of 
210 grams of iodate of soda, produced visible improvement. 
The disease process had rapidly extended regardless of the 
iodine treatment. Another horse with botryomycosis of the 
spermatic cord was given 750 grams of iodid of potash during 
a period of five months without visible improvement ; on the 
other hand, he soon developed symptoms of chronic iodism. 
The horse was operated and soon healed, Vennerholm, 
Konig, and Winter have recorded similar failures of 
iodid of potash in the treatment of botryomycosis of the udder. 
Topper hasalso spoken against the iodid of potash treat- 
ment ; he maintains that a trial is only indicated when the 
diseased tissue cannot all be removed by 
means of an operation. In any case items 
correct to advisethe owner ofa horse against 
the employment of an operation for the pee 
lief of botryomycpsis of the spermatic cord, 
in preference to the iodine treatment) aamnoee 
certain and rapid healing results from oper= 
ating as early as possible. 
III. TUBERCULOSIS 

SURGICAL IMPORTANCE. Whilein human surgery tuber- 
culosis of the bones, joints, and other external organs is of 
great practical therapeutic importance, the same form in 
domestic animals is of less significance. This is explained by 
the fact that tuberculosis of the external organs is far less 
common in animals than in man. Many valuable surgical 
operations employed upon man—resection of tubercular joints 
for example—are not practical in the lower animals. Finally, 
tuberculosis is found principally in slaughtered animals (cattle, 
swine); localized external tuberculosis is of slight importance 


TUBERCULOSIS 167 


to the animal; that form of external tuberculosis which is ’ 
secondary to a generalized type is incurable. : 

If, regardless of previous statements, tuberculosis of cattle 
from a surgical standpoint is somewhat exhaustively consid- 
ered in the following pages, it is due to the fact that such a 
classification has never found place in text-books on veterinary 
surgery. Like so many other chapters of surgical publications, 
the one under consideration has been sadly neglected. If 
tuberculous animals are excluded from surgical treatment, as 
has already been explained, the diagnosis of tuberculous 
changes, in itself, is of greatest importance, because of the 
close similarity of many tubercular affections to disease pro- 
cesses that may receive successful surgical treatment. Only the 
following are mentioned here: differential diagnosis 
of mastitis and metritis, tubercular arthrites and ten- 


_dovaginites as causes of different forms of lameness, as well 


as spinal tuberculosis as a cause of paralysis. Inall 
these cases an early diagnosis of a surgical affec- 
tion as tuberculous, and therefore, incurable, 
is of interest for the rapid repression of contagion (Oster- 
tag’s method of repression), as well as of economic interest 
tothe agriculturist. With reference to the etiology and 
pathogenesis of tuberculosis (tubercle bacillus) see text-books 
on special pathology. 

TUBERCULOSIS OF THE UppER.—In cattle this is usually 
secondary, due to emboli; it is seldom primary (entrance ot 
bacilli through the teats). Anatomically it may be a dissemi- 
nated miliary tuberculosis, a tubercular mastitis, or a localized 
tuberculosis. It usually presents the following symptoms: a 
diffuse, symmetrical, painless, seemingly firm 
Mmeaineg Of the posterior quarters, with 
swelling and enlargement of the supramam- 
mary lymph-glands. Later the swollen parts contain 
large or small firm nodules, on palpation these appear 
to be very hard. Other parts of the swollen udder gradually 
become as hard as a board or stone. Occasionally the udder 
becomes extremely large, the disease may extend from the 
posterior to the anterior quarters. Diminution in size of the 


168 TUBERCULOSIS 


udder, as shown in other chronic forms of inflammation, is 
never seen in tuberculosis of this gland (Rabe). In con- 
trast to other inflammations of the udder, the milk is at first 
normal; later it becomes thin, watery, mixed with floculi, and 
frequently contains bacilli (Bang). Diagnosis is confirmed 
by harpooning the udder (Nocard, Ostertag). Tuber- 
culosis of goats is far less frequent. As yet only one case 
has been observed in the horse (Parascandolo and de 
M eis). 

TUBERCULOSIS OF THE LyYMPH-GLANDS.—lInfection of 
the lymph-glands occurs partly through the lymph-stream, 
partly from the blood. Swelling and induration of 
the tubercular lymph-glands is due to the deposit of tubercular 
nodules, which afterwards become calcified, as well as to pro- 
liferation of the interfollicular connective tissue. The follow- 
ing glands produce forms of external surgical tuberculosis: on 
the head, the lymph-glands in the vViciimitgage 
the parotid; onthe neck, the superior (retropharyn- 
geal), middle, and inferior cervical ¢ lata 
the anterior extremities, the shoulder and axillary 
glands (shoulder lameness); on the posterior limbs, the 
inguinal and popliteal glands; on the udder, the 
pubic glands (supramammary glands) ; on the hips, the 
external iliac glands. Tuberculosis of the following 
glands belongs to the realm of inner pathology: those in the 
thoracic cavity, bronchial, and mediastiiaigeee 
well as intercostal and sternal lymph-glands; 
thosein the abdominal cavity, omental glands, lumbar 
and sacral glands, as well as the glands of tie 
liver, spleen, and kidneys. EHxtensive enlargement 
of the bronchial and mediastinal glands may lead to symptoms 
of surgical importance when they press upon the esophagus, 
causing symptoms of esophageal stenosis (chronic 
tympany). The other internal glands are of no surgical sig- 
nificance. Bruckmuller has observed a case of tubercu- 
losis of the thyroid gland in cattle. 

Johne and Roder have described a case of t uber- 
culosis of the glands of the shoulder ina horse, 


- 


TUBERCULOSIS 169 


it was in the form of a shoulder abscess. Nocard has dem- 
onstrated, through extirpation and bacteriological examina- 
tion, one case of tubercular disease of the intermaxillary 
gland ina horse that was suspected of having glanders. 
Rabe observed a case of tuberculosis of the intermaxillary, 
subparotid, and superior cervical glands, with compression of 
the larynx and high-grade inspiratory dyspnea ; the tubercular 
tumor weighed 3% kilograms. 

TUBERCULOSIS OF THE SKIN AND SUBCUTEM.—This form 
is very frequent in parrots, as a rule it is primary, in fifty per- 
cent of all cases only the skin isinvolved (Eberlein). 
Tuberculoma is found in the angle of the lids, on the eyelids, 
and on the top of the head. Upon and beneath the skin they 
form soft tumors from the size of a stick-pin to that of a hen’s 
egg, in form they are oval or round, they may also form kera- 
togenous structures in the skin that are easily broken. 
Occasionally one also finds small and large tuberculous 
ulcers onthe skin, in which large numbers of tubercle bacilli 
are demonstrated. Cadiot observed an interesting case of 
nasal tuberculosis in a cat, it was accompanied with extensive 
ulcerous destruction of the skin, of the mucous membranes, and 
the nasal and turbinated bones (Cf. Vol. III. Pg. 209 of this 
hand-book). Tuberculosis of the skin is not common in cattle. 
A few cases have been observed in cattle ; they were character- 
ized by the formation of caseated or calcified nodules on cir- 
cumscribed areas, or by the appearance of swellings the size of a 
hazel-nut to that of a walnut or a man’s fist over the entire sur- 
face of the body. Afterwards these swellings became soft and 
caseous, their contents contained tubercle bacilli (Huttner, 
imonredon, sDiegive, Stubbe,:Lacaze, Hanozat; 
Mischkin, Winter, Mackel, andothers). Godbille 
and Nocard observed the following case of tuberculosis of the 
subcutem in an ox: tubercular lymphangitis, with irregular, 
subcutaneous tumors arranged in rows; they were about the 
size of a man’s fist, and became fluctuating and ruptured on 
the external surface of the right anterior foot. In a dog 
Moller found a tuberculous ulcer on the throat, it was accom- 
panied by swelling of the lymph-glands. Inacat he observed 


170 TUBERCULOSIS 


subcutaneous tubercular nodules with swelling of the axillary 
glands. ‘Tubercular castration-cicatrices have been repeatedly 
observed in swine (infection from men ?). 

TUBERCULOSIS OF THE Mucous MEMBRANES.—This is 
most often found in cattle in the larynx and in the 
trachea inthe form of tuberculous neoplasms, ulcers, and 
nodular hyperplasias of the mucous membranes, or tubercular 
infiltration and abscess formation of the submucosa, the para- 
chondrium, and the adjacent musculature. ‘Tuberculosis of 
the mucous membrane is common in parrots, it affects the 
oral mucous membranes and conjunctiva in the 
form of tumorsand ulcers. Occasionally one observes in cattle 
an ulcerative, tuberculous stomatitis and glossitis 
(Moussu), as wellas tuberculosis of the nasal mucous 
membranes inthe form of numerous conglomerate fatty 
nodules on the nasal septum ; they vary in size from the head 
of a stick-pin to that of a pea, and are accompanied with nasal 
discharge and dyspnea (Zimmerman, Strerathy, Bol- 
linger, Kitt, and others). Johne and Eber have de- 
scribed a case of tuberculosis ofthe mucous membrane of 
the prepuce of an ox. Montfallet described a case of 
tuberculosis of the tongue in swine. Tuberculosis of the 
mucous membrane of the uterus in cattle is very common, 
that of the vagina is less frequently affected. ‘Tuberculosis 
of the uterus presents the following appearance: the mucous 
membrane is covered with yellowish-white tubercles, ulcers, 
caseous foci, and abscesses; the uterus contains a cloudy, 
greyish-red, ichorous fluid (identical with a bacilli-containing 
vaginal discharge), the serosa is covered with villous prolifer- 
ations ; occasionally the uterus is very much enlarged, the 
walls of the horns in particular become very thick, hard, 
nodular, and covered with ring-shaped constrictions ; the ovi- 
ducts often become thickened to the size of one’s finger. The 
sacral glands are usually enlarged and indurated. Tuberculosis 
of the vulva usually exists at the same time: on the inner 
surface one finds numerous indurated nodules the size of a 
stick-pin, as well as ulcers the size of beans(Hess). Tuber- 


culosis of the uterus is usually the result of tubercular peri-~ 


q 


TUBERCULOSIS Tet 


tonitis, itis rarely embolic ; and is seldom the result of infection 
at the time of copulation (De Bruin): 

TUBERCULOSIS OF THE BONES AND JOINTS.—Tubercu- 
losis of the bones is usually an incidental symptom of general- 
ized tuberculosis, and is, therefore, embolic. In most cases 
the primary seat is in the bone-marrow (osteomyelitis 
granulosa, caries centralis tuberculosa); itis 
characterized by the formation of greyish-red granulating foci 
and lacunar liquefaction (caries) of the osseous tissue, with 
central cavernous formation and caseation. In cattle and 
swine tuberculosis of the bones is often found in the following 
places: the dorsal vertebrae, lumbar vertebrae, 
cervical vertebrae (especially the first and second 
cervical vertebrze as a result of tuberculosis of the adjacent 
retropharyngeal lymph-glands), the petrous portion of 
the temporal bone, the sternum, and the ribs; 
it has also been observed in the ethmoid bone, frontal 
pone ,ocCcipital bone, humerus, pelvis, fem tir, 
onthe tibia, andinother bones. A peculiar forin of tubercu- 
losis of the middle ear (tubercular otitis media and in- 
terna) is observed in swine, it penetrates towards the brain, 
and develops from an infection of the pharyngeal cavity 
(Schutz, Siedamgrotzky). The tubercular inflamma- 
tion extends through the EHustachian tube, and then over the 
tympanic cavity ; it develops a tubercular periostitis, ostitis, 
and osteomyelitis, with rarefaction and necrosis of the bones, 
in this manner the process may extend to the cerebral men- 
inges, the cerebellum, and the medulla oblongata. The tuber- 
cular affection may extend to the external auditory canal, 
which becomes filled with a tubercular tumor. A secondary 
tuberculosis of the brain may develop in cattle in a similar 
manner from primary tuberculosis of the frontal bone (Ktn- 
nau, Moussu). ‘Tuberculosis of the petrous portion of the. 
temporal bone in a dog has resulted in unilateral facial paraly- 
sis (Montfallet). Hess hasdescribed a case of kyphosis 
in a steer caused by tuberculosis of the lumbar vertebre. 
Rieck observed a case of paralysis of the hind parts ina bull 
caused by tuberculosis of the sixth cervical vertebra, it resulted 


172 TUBERCULOSIS 


in severe swelling and compression of the cervical matrow. 
Knoll has observed two cases of sacral paralysis in swine 
following tuberculosis of the lumbar vertebre. Teetz has 
observed a case of paralysis in swine as a result of tuberculosis 
of the first cervical vertebra, Heyne has observed a similar 
casein a cow (seventh cervical vertebra, first dorsal vertebra). 
Schmidt saw a cow collapse with sudden paralysis ;. it was 
necessary to kill the animal, post mortem revealed tuberculosis 
of a lumbar vertebra and the adjacent spinal marrow. Haug 
has described a similar case. ‘Tuberculosis of the bones is 
common in birds. Cases of tuberculosis of the lumbar verte- 
bree, ribs, etc., have been observed in horses, sheep, and goats 
(Walley, Rasmussen, Magin). 

Tubercular arthritis is occasionally found in cattle 
in the hip-, elbow-, knee-, and carpal-joints (arth- 
ritis pannosa, granulosa, and caseosa), compare with the 
chapter on arthritis. It is most often seen in birds, especially 
in the joints of the feet and wings; it also occurs in 
Swine in the tarsal- and carpal-joints. By feeding tubercu- 
lous milk Nocard produced tubercular arthritis experimen- 
tally inacat. Cadiot observed tubercular gonitis ina dog. 
With reference totubercular tendovaginitis and bur- 
Sitis atthe carpal-joint (extensor carpi radialis), and knee- 
joint (extensor digitorum pedis longus) of cattle, compare with 
the chapter on tendovaginitis and bursitis. 

TUBERCULOSIS OF THE MUSCULATURE.—Thisis mostly of 
an embolic nature (generalized tuberculosis), it is not conimon 
and has no surgicalimportance. Inthe abdominal, thor- 
acic and appendicular muscles one finds round, 
firm, sharply circumscribed greyish-brown nodules ; occasion- 
ally they are arranged in rows; they may be miliary in form, 
or attain the sizeof alentil or bean. Tuberculosis of the 
tongue in parrots is more common, where it not infrequently 
leads to active tumor formation in this organ. ‘Tuberculosis 
of the tongue in cattle is less frequent ( Laquerriére, 
Godbille, and others); according to Ostertag only one 
case was found during a period of ten years in the abbatoirs in 
Berlin. 


TUBERCULOSIS 173 


TUBERCULOSIS OF THE EyrES.—While tuberculosis of the 
lids and conjunctiva is common in parrots, in cattle tuberculo- 
sisof the eyeis relatively rare. It usually develops inthe form 
of anembolic tuberculosis of the iris and choroid, 
and leads to destruction of the bulb, and transforma- 
tion of the same into a granular or caseous mass. 
In a three-year-old cow that was affected with tuberculosis of 
the lungs, Roder found tuberculosis of the righteye. Hess 
observed the following condition in a cow that was affected 
with tuberculosis of the lungs: symptoms of suppurative con- 
junctivitis, blindness, and atrophy of the bulb, first the left 
and then the right eye became affected. Post mortem revealed 
numerous white points in the anterior chamber, as well as 
fibrinous iritis, and white caseated nodules the size of a millet- 
seed. Ina slaughtered tuberculous cow Winter found the 
entire inner eye filled with a caseous mass; nodules from the 
size of a lentil to that of a pea were found on the schlera and 
cornea, where they were arranged in masses. 

In another case lentil-sized, yellow nodules were found on 
the anterior surface of the iris, it was also covered with yellow 
foci the size of the head of a stick-pin, the latter were arranged 
on the inferior margin of the iris, and were adherent to the 
cornea. Ina third case the retina wascovered with numerous 
tubercular nodules. Hdelman has described a tuberculous 
neoplasm that was located within the bulb of a tuberculous 
ox, it pressed the lens out of position and caused atrophy of 
the vitreous humor; the neoplasm possessed the consistency 
of a sarcoma, it was divided into cavernous spaces which were 
filled with a muco-purulent mass. Similar cases have been 
described by Moncet, Matthieu, Hess, Ripke, and 
Schmidt. Amaurosis resulting from pressure on the 
optic nerve from tubercular new-formations is less common 
(Fumagalli). | 

TUBERCULOSIS OF THE TESTICLES.—Many cases of this 
type have been demonstrated in cattle and swine inthe 
form of enlargement of the testicles, and deposits 
of numerous tubercular nodules, the nodules vary in size from 
a millet-seed to a walnut (Perroncito, Lydtin, Kitt, 


174 TUBERCULOSIS 


Johne, Fambach, Goring, Arens, Schmidt, and 
others). In one case in swine the right testicle weighed 3% 
kilograms, the left ro kilograms. Jensen has described a 
case in the cat. Hess has observed a tuberculous tumor as 
large as a goose-egg upon the epididymus of an ox. 
Meyer and others have described cases of tuberculosis of the 
spermatic cord, vaginal tunic, and vesicule 
seminales. Cadiot and Frauenholz have reported 
cases of tuberculosis of the prostate in cattle and dogs. 
The numerous cases of tuberculosis of the oviducts belong 
to the domain of inner pathology. 

TUBERCULOSIS OF THE BRAIN AND SPINAL MARROW.— 
Tuberculosis of the brain is not rare in cattle; it occasionally 
develops with symptoms of paralysis and conditions 
which are of surgical interest from a standpoint of differential 
diagnosis (paralysis of the facial, oculomotor, 
optic, trochlearis, hemiplegia, staggermag 
movements, torticollis). Symptoms of sacral 
paralysis and ataxia have been observed in tuberculosis 
of the spinal marrow, tubercular neoplasms in the lumbar 
marrow have been demonstrated by Johne, Steuding, and 
others. 

With reference to the treatment of tuberculosis, experi- 
mental extirpation of the diseased portion may be employed, 
as in man, (castration, ovariotomy). One may also experi- 
ment with aseptic injections of sterilized iodoform, emulsion 
of iodoform glycerin (10 per cent). These are injected into 
the diseased organs, for example, into dogs. 


CONCREMENTS AND FOREIGN BODIES. 


I. CONCREMENTS. 


GENERAL CONSIDERATIONS.—The name concrement is 
used to designate hard, stony excretions composed of the saline 
and organic constituents of the secretions and excretions of the 


1 


“Sa 


URINARY CALCULI 175 


animal body. Only a small number of these concrements are 
of importance in veterinary surgery. The majority, namely, 
intestinal stones of the horse, hair balls in the rumen and 
reticulum of ruminants, gall-stones, renal stones, and pan- 
creal stones are essentially conditions of inner pathology ; asa 
rule they produce only symptoms of internal disease, and, 
with few exceptions, are not amenable to surgical treatment. 
The following will receive brief mention : 

Peeuurinary calenl1, 
Bnicestinalicalenl. 
Bidwiwar y.ca lc Ul kK: 
Mie: Sark Cant. 
Preputial calcul, 
Free bodies in joints and tendon-sheaths. 

Dey CaLcuLI.—These either exist in the kidneys 
and the pelvices of the kidneys (renal calculi), orin 
the bladder (cystic calculi), they frequently become 
lodged in the urethra (urethral calculi). 

_ They are formed from the urinary salts, and are composed 
of calcium carbonate (carbonates), calcium oxalate (ox- 
alates), salts of silicic acid (silicates), uric acid and 
uric-acid salts (urates), and phosphates As ammonia and 
magnesia (triple phosphates). The formation of uri- 
nary calculi is favored by the presence of foreign bodies on the 
one hand, especially the organic albumenous products of 
inflammation of the mucous membranes of the bladder and 
pelvices of the kidneys, around which, as a nucleus, the urinary 
salts are deposited, and bacteria on the other hand, these cause 
degeneration of the urinary products to ammonia (ammoniacal 
urinary fermentation), thereby making possible the formation 
of triple phosphates. 

In the horse urinary calculi are composed largely of 
calcium carbonate with traces of calcium oxalate, and iron. 
Cystic calculi form egg-shaped or flat, hard, yellowish stones, 
the surface is smooth, mulberry-like, or has the appearance of a 
gland; in size they vary from that of a walnut to one’s fist 
or larger. Frequently a few, and even many small calculi 
are present inthe bladder. By constant wear they produce 


DAP YS 


176 INTESTINAL CALCULI 


facet-like surfaces on one another; in addition to these one 
also finds a gravel- or sand-like sediment (urinary gravel, uri- 
nary sand). The weight of cystic calculi varies between 
10 and 1000 grams. Urethral calculi are similar in character 
but smaller, they vary in size from a hazelnut to that of a 
chestnut, and average from 10 to 15 grams in weight. They 
are usually situated in the vicinity of the posterior border of 
the ischium. 

Cystic calculi in cattle possess the following character- 
istics: they are usually numerous, small in size, from a lentil 
to a pea, pearl-like, of a metallic goldish-yellow or goldish- 
brown lustre, and covered with facets. In oxen and steers 
they are usually found lodged in the S-shaped curve of the 
urethra. They are composed of the carbonates or oxalates of 
lime, or of silicates. 

In dogs the cystic and urethral calculi are usually small, 
from the sizeof a grainof sand to a pea, and they often 
exist in large numbers. Solitary cystic calculi, from the 
size of a hazelnut to a chestnut, arelesscommon. From lying 
against one another their surfaces are frequently smooth and 
covered with facets similar to the cuboid, one often finds, how- 
ever, a rough, gland-like, warty surface. Urethral calculi in 
dogs usually become lodged in the gutter of the bone of the 
penis, so that the entire urethra as far as the bladder is filled. 
Occasionally one finds a sand-like incrustration of urinary sed- 
iment on the mucous membrane of the urethra. The urinary 
calculi of the dog are composed largely of urates, triple phos- 
phates, and oxalates. 

The treatment of urinary calculi is purely operative ; 
it consists in incision of the bladder Kcyeto eae and the 
urethra (urethrotomy ). 

INTESTINAL CALCULI.—In the horse these are formed in 
the large intestines, by getting lodged in the rectum, or at the 
point where the colon terminates in the rectum, they become 
the cause of so-called calculous colic. They consist essentially 
ofthe triple phosphates which are derived from the 
phosphates of magnesia in the food (bran) and the ammonia 
in the air of the stall. The phosphates of ammonia and mag- 


SALIVARY CALCULI 177 


nesia frequently crystalize around an oat, a nail, a button, a 
grain of sand, etc., which serves asa nucleus. ‘Their size is 
variable, the large ones reach the size of a large nine-pins ball 
and weigh from 5 to1o kilograms. Intestinal calculi are of 
surgical importance when they can be reached per rectum. 
Operative removal .by means of laparotomy and intestinal in- 
cision is as good as hopeless. Félizet successfully removed an 
intestinal calculus by this method ; on the other hand those 
cases in the horse terminated fatally that were operated on by 
Mees tat, Rickards, and Hatt, 

Hair-balls (bezoare, phytobezoare, zegagropila) in the 
rumen and reticulum of ruminants are composed of matted 
hairs and plant fibers. Incattle they reach the size of an apple 
to that of one’s fist. When regurgitated they occasionally ob- 
struct the esophagus producing symptoms similar to those of 
foreign bodies in the esophagus (tympany). In these cases 
operative treatment is indicated (probang, esophagotomy ). 
| SALIVARY CaLcuLiI.—In herbivora these are found in 
Steno’s duct (horse, cow, ass). They consist largely of the 
salivary salts, namely, calcium carbonate (80 to go per 
cent), besides phosphate of lime and organic material; they 
have a chalk-white or yellowish-white color and occasionally 
reach a considerable size, when they become as large as a 
goose-egg and weigh 500 grams. Solitary calculi are oval or 
sausage-shaped, they are covered with numerous facets. A 
foreign body is usually found in the center of the calculus (oat, 
etc.). They are removed by means of an operative opening in 
the salivary duct, orthrough the mouth. The so-called dental 
calculi on the teeth of horses and cattle are composed of the 
same materials as salivary calculi, calcium carbonate is the 
main constituent.—Calcareous concrements in the tonsils are 
very rare. 

FREE BopiEs.—The name free body (corpora 
Mipex deere orpora oryzoidea, rice-like bodies, 
chondroids, joint- mice ) indicates an organic structure 
Meppoumes.) tendon-sheaths, mucous bursae; 
subcutaneous hematomata, and the guttural 
pouches of the horse; these structures are variable in 


178 FOREIGN BODIES 


character. More than a hundred chondroids have frequently 


been found in the guttural pouch. They are composed partly | 


of coagulated, inspissated, hardened, calcified products of 
inflammation, partly of constricted neoplasms or desquamated 
bone or cartilage. See chapter on diseases of the joints. 


M1LkK-CaLcuLi.—This is a name that indicates concrements in the 
milk-cysterns or in the teats. They are variable in form, yellowish-white 
or grey in color, and about the size of an oat orbean. They consist of 
calcium carbonate,(go percent), casein, and fat. Weille has 
described a case in a heiferin which 22 milk-calculi were removed at an 
operation, their collective weight was 72 grams.—The so-called pros- 
tatic calculi are similar concrements which are formed from the 
sedimental deposits from the secretions of the prostate.—Preputial 
Calculi. Concrements known as preputial calculi, or calculi 
of the glans penis, are found inthe preputial sac of horses and 
boars. They are ovalor lenticular in form, smooth or sharp, rough, 
and formless. They consist largely of inspissated smega, occasionally 
they cause retention of the urine (urinary colic). 


II. FORHIGN BODIKS. 


GENERAL CONSIDERATIONS.—Aside from foreign bodies 
that are formed within the animal body itself (concrements) 
many other foreign bodies from without gain entrance to 
numerous portions of the body. In some ways they are of 
more importance to internal medicine than tosurgery, namely, 
foreign bodies in the anterior stomachs of the ruminant (trau- 
matic inflammation of the stomach, diaphragm, and heart). 
In many cases they produce conditions that necessitate surgical 
interference. To this class belong foreign bodies of the 
mouth-cavity, the pharynx, esophagus, stom, 
ach, intestines, the nasal cavities, the gms 
junctival sac, skin, subcutem, muscle, and hoof. 

FORHIGN BODIES OF THE MoutTu Cavity.—These are 
most often observed in dogs, cats, and horses, where they 


cause symptoms of salivation, stomatitis, and difficult mastica- — 


tion ; in dogs, under certain conditions, they even produce 
symptoms similar to those of rabies. When such symptoms 
exist in these animals careful examination of the mouth cavity 


should not be omitted. ‘The following bodies are found 


ee 


FOREIGN BODIES 179 


between the teeth, in and under the tongue, in the gums, 
in the mucous membranes of the cheeks, at the openings 
of the secretory ducts/of the salivary glands, etc.: pieces of 
bone-splinters, grain, pieces of wood, needles, 
particles of straw, and other sharp bodies. Sometimes 
the tongues of cats and dogs, as well as birds, become ligated 
with pieces of string or hair, they may also become con- 
stricted with pieces of the trachea, transverse sec- 
mronus Of the aorta; rubber tubes, and iron 
rings. Incattle, even green stalks of sharp, pointed barley 
with long roots have been observed upon the tongue. Oats, 
rye, awns, and particles of straw have been found in the ex- 
cretory ducts of the salivary glands. These foreign bodies 
pass out of the mouth cavity and sometimes follow a peculiar 
course. Needles and grain-awns have been found in the cra- 
nial cavities of horses and swine; a piece of metal was found 
in the Eustachian tube of a dog ; blades of straw and kernels 
of grain in the orbital cavity and temporal fossa of a horse. 
FOREIGN BODIES IN THE PHARYNX AND ESOPHAGUS.— 
These are especially frequent in horses and cattle, where they 
cause symptoms of pharyngitis, difficult deglutition, stenosis of — 
the esophagus, and even perforation of the esophagus. The 
most important foreign bodies are bones, pieces of meat, 
fish-bones, bacon-rinds, masses of fat, pieces 
eortendon, potatoes, beets, apples, pears, pieces 
of linseed cake, balls of food,eggs, sauerkraut, 
plum-stones, pieces of wood, needles, pills, 
teeth, forks, knives, spoons, coins, pieces of 
cloth, hair-balls, broken pieces of whip-han- 
dles and probangs, balls of oakum, and remains 
of the afterbirth. Their removal is often very difficult. 
Treatment consists in the administration of emetics (apomor- 
phine, veratrin), agents which stimulate the secretions of the 
salivary glands (arecalin, pilocarpin), passing the probang 
and esophagotomy. ‘Those cases in which the foreign body has 
penetrated the thoracic portion of the esophagus are incurable 
(pleuritis) ; occasionally a foreign body causes an injury to 
the anterior or posterior aorta resulting in internal hemor- 


180 FOREIGN BODIES 


rhage, or an aneurysm of the aorta.—In the guttural 
pouches of the horse, aside from the chondroids which 
reach the size of a chestnut toa hen’s egg, there may be found 
necrotic portions of the bone (os hyoides), as well as pieces of 
food which occasionally fill the entire sac. In ome casea 
musket-ball three centimeters thick was found in the guttural 
pouch of an old military horse (Rigot). In another case 
fungoid growths of aspergillus fumigatus were found in the 
guttural pouches (Ries). 

FOREIGN BODIES IN THE STOMACH AND INTESTINES.— 
The greatest variety of blunt and pointed foreign bodies are 
found in the anterior stomachs of the ruminant, especially 
in the reticulum of the ox. Pointed foreign bodies 
‘penetrate the gastric wall, the diaphragm, pericardium, and 
heart, causing a characteristic disease marked by chronic indi- 
gestion and severe cardiac symptoms (traumatic carditis and 
gastritis). In their wanderings the foreign bodies often pass 
outwards through the skin; their passage is characterized by 
the formation of phlegmons, abscesses and fistule of the 
thoracic and abdominal regions. The most common sharp 
foreign bodies are: nails, pins, darning-needles, hair- 
pins, sewing-needles, cobbler’s needles, pieces of wire, sharp 
remnants of iron and metal plate, screws, knives, shears, forks, 
pieces of glass, splinters of wood, pieces of stone, sharp angular 
pebbles, sharp pieces of lead, pieces of thorns, branches of 
vines, steel umbrella-ribs, and broken umbrella-sticks. The 
most common blunt foreign bodies are: stones, pieces of brick, 
gravel, sand, coal, pieces of wood, cork, cabbage-stumps, 
apples, pears, hair-balls, bullets, spoons, pieces of coin, leather 
straps, soles of shoes, pieces of cloth, pieces of clothing, neck- 
ties, strings, laces, buttons, frogs, toads, striped snakes, adders, 
and poisonous plants. Surgical treatment of these foreign 
bodies consists in the much-employed laparotomy and gas- 
trotomy (incision of the rumen). Foreign bodies in the stom- 
ach and intestines of do gs (bullets, coins, stones, cork, hair- 
balls, pieces of teeth) are occasionally removed by means of 
emetics and purgatives. Otherwise, when symptoms of death 
appear, they must be removed by means of laparotomy. The 


ns (ee 
\g 
= 

bans 


FOREIGN BODIES 18I 


prognosis of enterotomy in the dog is not unfavorable; it has 
been employed with good results by Siedamgrotzky, 
Frohner, Degive, Pl6sz, Krause, and others. Occa- 
sionally foreign bodies in dogs and horses pass away spon- 
taneously (champagne-cork in a dog, curb-chain in a horse). 
It sometimes occurs that foreign bodies, especially coins, 
remain in the stomach of a dog for a long time, even years, 
without causing trouble. A five-frank piece remained in the 
stomach of a dog for twelve years without giving rise to in- 
jury, a top for one year (Nichoux, Cadiot). In addition 
to the above foreign bodies, one finds the following in the 
rectum of the dog and cat: hard feces, fish-hooks, ker- 
nels of grain, and other bodies which gain entrance from 
without. In the urethra, kernels of grain and broken pieces 
of catheters have been observed; artificial ligatures have 
been observed around the penis in dogs (ribbons, etc. ). 


FOREIGN BODIES IN THE RESPIRATORY TRACT.—The 
following have been observed in the nasal cavities and 
Superior maxillary sinuses of the horse: pieces of 
food and bone, sponges, wisps of straw, oakum, tampons, 
pieces of wood, blackberry twigs, hog’s bristles, apples, pieces 
of bandage, and moulds (mucor spinosus). Inthe larynx 
and bronchi have been found pieces of cartilage, as well as 
portions of a tracheotomy-tube, aspirated stones, and grain- 
awns. Rhinoliths are rare; this type is usually seen in the 
guttural pouches in the form of corpora oryzoidea. 


FOREIGN BODIES IN THE HYE AND HAR.—Foreign bodies 
in the conjunctival sac, especially beneath the mem- 
brana nictitans (kernels of grain, awns, pieces of wood), are 
the cause of a unilateral purulent conjunctivitis. When a 
unilateral blennorrhea exists, careful examination of the entire 
sac for the presence of foreign bodies should not be over- 
looked. ‘Treatment consists in removal under the influence of 
cocain. Foreign bodies in the external auditory 
canal are usually in the form of parasites ; occasionally they 
gain entrance to the middle ear (tympanic cavity ), bird-mites, 
in cattle, mange-mites in rabbits, larvee of fleas, and fleas 


182 FOREIGN BODIES 


(simulium) in animals at pasture. In addition to these, 
masses of secretions from the ceruminous glands, water, sand, 
splinters, beards of grass, and gravel stones have been found. 

FOREIGN BODIES IN THE Hoor.—N ails and fragments 
of glass are most frequently found. They usually enter at 
the lateral or median cleft of the frog. Nails sometimes pene- 
trate the soles of cats and dogs. 

FoREIGN BODIES IN THE SKIN, SUBCUTEM, MUSCLES, 
BONES AND INTERNAL ORGANS.—Bullets, needles, 
splinters of wood, and other foreign bodies enter the 
body through the skin. By acting as carriers of filth, dirt, 
and other unclean material rich in bacteria, they set up sup- 
purative and septic inflammations (phlegmons, 
abscesses); when the foreign bodies are aseptic healing occurs 
without reaction, especially without suppuration. 
The latter is especially true of shot and bullets, which may 
become encapsuled and remain in the body without causing 
injury. Foreign bodies that are soft and composed of animal — 
tissues are resorbed by means of phagocytosis and liquefaction 
(catgut, pieces of lung, liver and kidneys that are experi- 
metally transplanted into the abdominal cavity). 

Other foreign bodies would include the entrance of air 
into the veins and heart, as well as phlebotomy instruments 
that gain entrance to the heart by passing through the, wounds. 
in the vein (funnel, blades of a lancet). Itis a peculiar fact 
that heart-muscle is relatively non-sensitive to injuries from 
foreign bodies ; this is demonstrated in those cases of traumatic 
carditis in the ox, where the function of the heart is not sus- 
pended for weeks and months, although severe chronic changes. 
are taking ‘place. With reference to retention Of@tae 
afterbirth see text-books on obstetrics. 


PARASITES. The following parasites, which may be considered as. 
living foreign bodies, are of surgical importance: 

1. Coenurus cerebralis (the worm which causes staggers) 
develops in sheep and cattle, occasionally in horses, dogs, and goats. 
In the brain they result in symptoms of paresis, and occasionally pro- 
duce local symptoms (amaurosis); in the spinal marrow they may cause 
symptoms of sacral paralysis. Treatment of the cerebral bladder-worm is 
operative (trepanation, puncture). 


FOREIGN BODIES 183 


2. Oestrus ovis (gad-fly) in sheep causes symptoms of ehronic 
catarrh of the nasal cavities, and the frontal and maxillary sinuses 
(disease caused by the cestrus larvee). 

3. Gastrophilis larvae occasionally produce proctitis in the 
rectuni of the horse, they seldom cause injury in the pharyngeal cavity. 
Gastrophilis nasalis is very rare in horses (nasal discharge, sus- 
pected glanders). 

4. Pentastomum taenoides (lingulata teenoides) is para- 
sitic in the nasal cavities of the dog (rarely in horses). They cause 
symptoms of severe, sanguino-purulent rhinitis. 

5 Hypoderma .bovis (cestrus humanis) lives in the larval: 
form in cattle, where it causes boil-like swellings as large as a walnut in 
the skin (cestrus abscesses). These are subcutaneous abscesses, and 
they communicate with the surface of the skin by asmall opening, 
through which the larve finally pass out. Cistrus abscesses have also 
been observed in military horses and English sale-horses in the follow- 
ing places: in the saddle-region, on the withers, on the buttocks, on 
the neck and abdomen (Hell and others). Ina case described by 
Ducasse he found a larva of hypoderma (bovis?) one and one half 
centimeter in length in the medulla oblongata of a horse affected with 
paralysis. Treatment consists in incision of the abscesses. Chronic 
connective-tissue proliferations occasionally develop around the dead 
larvee, their consistence is very hard and they finally become calcified 
(hy podermoliths of Caparini). 

6. Filaria papillosa lives parasitically in the horse in the 
anterior chamber of the eye, where it causes a severe inflammation of 
the iris and cornea. It may be removed through an incision in the 
cornea ( Vandevelde, Monatshefte fur praktische Tierheilkunde. 1895). 
The same parasite is found in the horse in hydrocele, ascites, and 
eryptorchids. 

7. Filaria lachrymalis is a harmless parasite found in the 
excretory ducts of the lachrymal glands, occasionally itappears to cause 
a conjunctivitis of the lids. 

8. Filaria (Spiroptera) cicninnati (s. reticulata) is a 
cause of tendinitis of the suspensory hgament, it causes an incurable 
lameness (Mauri). Occasionally they cause a fibroma-like neoplasm 
in the vicinity of the flexor tendons, which reaches the size of a hazelnut 
to a dove’s egg (Frohner, Bartels). They are also found in the 
tendon-sheaths of the flexor tendons, in the walls of the tibial artery, 
-and in the ligamentum nuchz (I once found them in the latter place 
when operating fistula of the withers). One case has also been observed 
in the subcutem of the horse (Bassi). 

9. Filaria hemorrhagica (filaria irritans) develops in horses. 
at pasture, especially in Russia and Hungary. It is found in various 
parts of the body (withers, shoulder, neck), where it forms hemorrhagic 


184 FOREIGN BODIES 


cutaneous nodules the size of a pea, so-called granular dermatitis. The 
parasite lives in the subcutaneous tissue and can be demonstrated by 
means of an incision. In general, treatment is superfluous. (For details 
concerning this organism see ‘‘Special Pathology and Therapeutics,’’ 
Friedberger and Frohner. Sixth Ed., 1904, Vol. I). | 

10 Filaria medinensis occurs. as in men,in the subcuta- 
neous connective tissue of horses and dogs (Africa, India, Brazil). 

Ir Cysticercus cellulosae (measles) is occasionally seen in 
the eyes of swine. In one case they were found in a tumor on the knee 
of adog (Meyerstrasse).—Echinococci in the frontal sinuses of 
the horse cause symptoms of empyema (Preuss. Mil. Vet. Bericht. 1898). 

12. Strongylus armatus isfound in the thickened nasal mucous 
membrane of the horse (Lammers). It also causes peritonitic pro- 
liferations on the tunica vaginalis of the testicles (Hinrichsen), and 
is not rare in cryptorchids (personal observations). Strongylus-like 
nematodes have also been observed in the membrana nictatans of pup- 
pies in France and America, where they were the cause of a contagious 
inflammation of the eyes (Hmmerz, Mégnin). 

13. Spiroptera sanguinolenta produces cysts in the walls 
of the esophagus in the dogs of Java, this results in stenosis. . 

14. Distomum hepaticum is occasionally observed in the 
scrotum of the horse as an incidental condition during castration 
(iii er): 

I5. Sarcosporidia (psorospermia, Miescher’s tubules) cause 
symptoms of myositis in the horse ; compare with the chapter on diseases 
of the muscles. 

16. Horse-leeches (hemopis vorax) are occasionally found in 
horses and cattle in the mouth-cavity, pharynx and larynx (pharyngitis, 
laryngitis, chronic marasmus). 

17. Ixodes ricinus (mites) induce circumscribed inflammation 
of the skin of dogs; one case of acarus of the conjunctival sac has 
occurred in dogs (lower border of the cornea), it caused severe conjunc- 
tivitis (Tierarzneischule in Pisa; Clinica veterinaria. 1897). 

18 Simulium maculata, and Simulium ornata and 
reptans cause inflammation of the skin and mucous membranes of 
the head with severe swelling (dyspnea, asphyxia, poisoning) in animals 
at pasture. According to Bergmann the best protective is creolin 
in oil or fish-oil (I to 20). 


HERNIAS 185 


CHANGES IN POSITION OF VISCERA. 
I. HERNIAS. VISCERAL HERNIAS. 


NATURE. The term hernia indicates the passage of 
viscera from body-cavities without an injury 
to the skin or mucous membranes. Changes in 
position of the viscera which are accompanied by a rupture of 
the covering skin or mucous membrane so that they are exposed 
to the air are termed prolapse. While ina broad sense 
the term hernia applies not only to abdominal viscera, but also 
to lungs, brain, and muscle; in a*narrow sense one under- 
stands by the term hernia, a change in position of the abdominal 
viscera. According to the seat they are named as follows: 
Mminmviiscal hernia, ,ingtlinal hernia, scrotal 
hernia, ventral hernia, hernia of the flank, 
Bemaral hernia, perinealhernia, rectal hernia, 
vaginal hernia, diaphragmatic hernia, and 
Other internal hernias. 

In every hernia the following parts are recognized: 1. 
The mouth (hernial opening), that is, the opening in the 
abdominal wall through which the viscera pass ; 2, the hernial 
sac, that is, the sac-shaped, protruded peritoneum covered 
with skin or mucous membrane ; 3, the contents (intestine, 
omentum, bladder, stomach, liver, uterus). The margin of 
the mouth of the hernia is termed the hernial ring. The 
hernial sac consists of a mouth, neck, body, and fundus. 
According to the contents of the hernia one speaks of an 
enterocele (intestinal hernia), epiplocele (omental 
hernia), gastrocele (gastric hernia), entero-epiplo- 
cele, cystocele, hysterocele (hernia of the uterus), 
hepatocele, oopherocele. Inaddition to the essential 
contents hernias contain a serous fluid, hernial water. 

With reference to the mobility of the hernial contents, 
they are classified as reducible (moveable, free), that is, 
they may be pushed through the hernial mouth into the 
abdominal cavity ; andirreducible (immoveable), that is, 
a hernia. that cannot be returned. The immobility is due, 


186 SYMPTOMS 


either to adhesions between the hernial contents and the 
hernial sac, which is especially common in omental hernias 
(immobility of the omentum); or to incarceration 
(constriction, strangulation) of the prolapsed viscera, this is. 
especially frequent in intestinal hernias. 

With reference to the causes of hernias, they may be 
congenital or acquired (traumatic). 

SyMproms.—1. A reducible hernia is characterized by 
alarge or small hernial swelling which occupies a char- 
acteristic seat in the umbilical or inguinal region, ete. The 
swelling is painless, is not characterized by a rise of tempera- 
ture, and has a soft peculiar consistence ; the skin is moveable 
on the surface, occasionally one may easily palpate intestinal 
loops or pieces of omentum at its base. Percussion occasion- 
ally gives a tympanitic sound (air in the intestinal loops); on 
auscultation one can occasionally hear rumbling or gurgling 
peristaltic sounds. On pressure the swelling be- 
comes smaller and finally entirely disappears 
in the abdominal cavity. Palpation of the abdominal 
wall reveals the hernial mouth, it varies in size from a pea to that 
of one’s fist; in form it is round, oval or elongated, whenever a 
hernia has existed for a long time the free margin of ring 
becomes firm and tendinous. In rare cases the abdominal 
sac becomes ossified in cattle. 

2. Incarcerated hernia, especially in (horsesmae 
first recognized by colic (strangulated inguinal hernia of 
stallions); in dogs and swine one further observes vomiting, 
and even stercoraceous vomiting;constipation is pres- 
ent in all animals. On local examination one finds an 
inflammatory swelling at the seat of the hernial 
sac; attempts to return the hernial contents are unsuccessful. 

TREATMENT.—One must differentiate between the treat- 
ment of a reducible and an irreducible hernia; the 
reducible form may receive either provisional (palliative) 
or definitive (radical) treatment. It should also be observed 
that many forms of hernia, especially those of the umbilical and 
ventral regionsin horses and cattle, heal spontaneously 
(cicatrization). On the other hand, many forms with a very 


TREATMENT 187 


wide mouth (ventral hernia) are incurable, especially in 
horses and cattle. Finally, many forms of non-incarcerated 
hernias, especially those of the umbilicus, require no treat- 
ment as they do not usually result in diseased conditions 
(colic, ete. ). 

1. The palliative treatment of non-incarcerated 
hernia consists in the application of an abdominal band- 
age, this is especially useful for umbilical and ventral hernias. 
of dogs, foals and mares. The prolapsed viscera are pressed 
back into the abdominal cavity by the abdominal bandage, 
this is followed by a gradual diminution in size of the hernial 
mouth. 

Palliative treatment is further employed in the form of 
return of the hernial contents by means of pressure and reduc- 
tion of the hernial sac by means of artificially devel- 
Oped inflammation and cicatricial formation, 
in its vicinity. For this purpose the following agents have 
been employed: blisters (calcium dicromate 1-8 or 10), 
firing the skin of the hernial sac, applications of sulphuric 
Peraenittic acid, c¢htomic acid, as well as subcu- 
taneous injections of alcohol, salt, and other 
irritating materials. The efficiency of this method is still 
questionable. At any rate it is not without danger. Gan- 
grenous necrosis of the skin with prolapse of the intestines has 
followed the application of acids; subcutaneous injections 
have been followed by severe phlegmons and fatal peritonitis. 
Other palliative remedies are ligation, clamping, and 
suturing of the hernial sac. : 

2. The radical operation consists in exposure of the 
hernial sac (herniotomy). The mouth of the hernia is. 
sutured with, or without, subsequent extirpation of the hernial 
sac (inverted into the abdominal cavity). Herniotomy is the 
surest method of treatment of a hernia because it not only 
removes the hernial sac but obliterates the mouth. Experience 
has taught that mere suturing, clamping, or binding the 
hernial sac is occasionally followed later by the passage of 
viscera through the remaining hernial mouth, this results in. 
the gradual formation of a new sac. 


188 PROLAPSE 


3. Treatment of an incarcerated” hema 
consists first in the return of the strangulated viscera (taxis) 
through manual reposition, dorsal position, combined attempts 
from without and inside the rectum, placing the hind limbs in 
a special position to favor enlargement of the inguinal ring, as 
well as deep narcosis of the animal by means of chloroform. 
If reposition is not successful by this method, the constricted 
hernial moth (implication of the tunica vaginalis) must be 
enlarged by means of a hernial incision (herniotomy ), 
taxis may then be successfully employed. ‘The return of the 
strangulated hernia must be preceded by careful disinfection, 
as well as resection of any necrotic portion (intestinal suture). 
In stallions, herniotomy of an incarcerated 
inguinal herniais usually followed by castra- 
tion with the use of clamps and the coves 
operation. 


II, PROCIDENTIA. PROLAPSUS. 


DEFINITION.—Prolapsus (prolapse) is a free 
passage of viscera through natural or arti- 
ficial body-openings without a covering of the skin 
or mucous membrane. Asa rule the causes are traumatic in 
nature. ‘Thus, rupture of the abdominal wall results in pro- 


lapse of the intestines and other abdominal viscera; severe 


efforts at abdominal pressure, prolapse of the rectum ; stretch- 
ing and relaxation of the uterine ligaments, prolapse of the 
vagina and uterus; penetrating thoracic wounds, prolapse of 
the lungs ; severe wounds of the skull are followed by pro- 
lapse of the brain; bites of the eye, prolapse of the bulb; 
rupture of the vaginal wall, prolapse of the bladder ; paralysis 
of the penis and tongue, proplase of these organs. 


f Prolapse should not be confused with eversion (i n-) 


version, inflexion) of a hollow organ (bladder, uterus), 
or with intussusception (invagination) of a sec- 
tion of the intestine or vagina into itself. Prolapsus vesicze 
is a prolapse of the bladder through the ruptured vaginal floor 
into the vagina, or outwards through the vulva : inversio 


PROLAPSE 189 


vesice is an outward inversion of the bladder through the neck 
of the bladder and the urethra. jin veterinary science the 
nature of prolapsus, inversion, and invagination is not always 
sharply distinguished. So-called prolapsus recti is often pro- 
lapse of the rectum with invagination ; so-called prolapse of 
the uterus and vagina, an inversio uteri and vagine with 
prolapse. | 

Symptoms.—The symptoms of. prolapse are extremely 
variable according to the organs affected. 

1. Prolapse of the intestines consists in the pro- 
trusion of portions of the small intestines, colon, and even 
ezecum, through penetrating abdominal wounds, through the 
inguinal canal after castration, or through a hernial ring after 
herniotomy. It is always a very dangerous accident. Reposi- 
tion must be accompanied by careful disinfection of the pro- 
lapsed intestines, taxis is followed by accurate suturing, cas- 
tration by the covered method may be necessary. 

2. Prolapse of the omentum most often occurs 
after castration, or following perforating abdominal wounds. 
It is far less dangerous than prolapse of the intestines. Treat- 
ment consists in careful disinfection, ligation, incision of the 
stump, return of the stump, and careful suturing of the wound. 
Castration by the covered method may be employed. 

3. Prolapse of the rectum is partly a prolapsus 
ani, partly a prolapsus recti, with or without invagination. It 
is a result of abdominal pressure from straining, chronic 
diarrhea, rough exploration, etc. It is most frequently ob- 
served in dogs, cats, and swine, less often in horses. The 
prognosis should be made with caution, reposition, regardless 
of sutures, is frequently of no permanent value, so that one 
must employ amputation of the prolapsed parts. 

4. Prolapse of the vagina occurs in cattle as an 
inversion of a portion of the vagina (incomplete prolapse), less 
frequently in the form of an invagination of the entire vagina 
with a simultaneous prolapse (complete prolapse). It may 
follow traumatic influences as a result of parturition. A pos- 
terior dispiacement of the uterus when accompanied by atony 
of the uterine ligaments, so-called habitual prolapse, may occur 
in cows which occupy positions with the hind parts the lowest. 


190 DISEASES OF BONES 


5. Prolapse of the uterus is especially common 
‘in cattle, it is caused by rough manipulations at the time of 
birth ; inversion with prolapse is also due to continued strain- 
ing. Reposition, and retention especially, is occasionally 
‘dificult, so that amputation is sometimes required. 

6. Prolapse of the penis is observed in paralytic 
conditions, as well as in paraphimosis. Prolapse of the 
tongue is either the result of rupture of the muscle, or 
paralysis (it should not be confused with the ordinary blemish 
in which the tongue is protruded). Prolapse of the bulb is 
most often observed in dogs (pugs) as a result of bites; treat- 
ment consists in reposition or amputation. Prolapse of the 
membrana nictitans is observed’ in tetanus. In ad- 
‘dition to these are inversion and prolapse of the bladder, 
prolapse the of pododerm, prolapse of the iris, prolapse of 
the posterior corneal membrane through a corneal ulcer (kera- 
tocele), forward protrusiof of the cicatricial cornea 
Ccornealistaphy Loma), 

The following internal changes in position of viscera are 
of surgical importance: torsion and anteversion of 
the uterus incattle, twisting of the left colon on 
its axis in horses. Twisting of the stomach on its axis 
is occasionally observed in dogs, as well as luxations and 
torsions of the spleen in swine. With reference to changes 
in position of the uterus, and abnormal positions of the 
fetus, see text-books on obstetrics. 


DISEASES OF BONES. 
I. BROKEN BONES. FRACTURES. 


PRELIMINARY REMARKS ON ANATOMY AND PHYSIOLOGY.—Normal 
‘bone is composed of three principal constituents: the periosteum, the 
genuine bone-substance (tela ossea), and the bone-marrow. From a 
‘surgical standpoint the periosteum is of greatest importatice in diseases 
of bone, this is especially true of fractures. The bone-marrow 
(endosteum), from a standpoint of veterinary surgery, stands next in 
importance. Im diseases of the bone the tela ossea plays a less 
‘important part. 


Pak 
[S. R. No, 70, C. No. 1.] 


4 
. 
; Fi Vane, - ‘ 
: & ede: ay 


SPECIAL REGULATIONS | i 


We. 
‘ 
CHANGES WAR DEPARTMENT, ee ; 
No. 1. WASHINGTON, Judy 5, 1918. 
et 


Paragraph 155, eheclal Regulations No. 70, Army Veterinary 

Service, 1917, is rescinded, paragraphs 17, 19, 20, 22, 25, 2¢ °28, 

30, 33, 35, 37, 42, 45, 46, 47, 48, 49, 50, 51, 52, 54, 55, 56, 57, 58, 59, 

z 61, 62, 68, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 
~~ 80, 81, 83, 84, 85, 86, and 87 are changed, And paragraphs 133, 874, 

rf ‘eo and 873, and section V (par. 156) are added, as follows: 


CAMP VETERINARIAN Ss 


Gee SR. 70 tov gy i-2-5-4-Sb-F-¥* Selanttran bah Bi all 
133. The veterinary service of a camp‘is under the ditlectidid : is : 
of the senior veterinary officer on the staff of the famp Come sh 
mander, who will be designated as camp veterinarian. “His * 


duties as regards the camp veterinary Service, including — aN 
and. dairy inspection, are the same as” A neat ecified herei me 


- necessary veterinary ‘service to units or organiza tions” ha 
no ee 7 (S. R. No. 70, C. No. 1, July 5, LS 
. 062.12, 


¢ S.A. 70 ¥o8 Paws a 
Sit will mt Pa [Best i reports on Forms Tie Mey and — 


pig M. D., in duplicate, retain one copy and forward one dibeet 
to the Director of the Veterinary Corps, Office, of the Surgeon : 
General. (8S. R. No. 70, C. No. 1, July 5, 1918.) ° 


[062.12, A.G. O.] 
See $.%.70 tar Po @ 
19. He will prepare a’report on Form 102, M. D., for the week 


ending at noon oi - each Friday. This report will include all 
animals in the camp, exclusive of those at the auxiliary remount 
_ depot, . and is practically a consolidation of the daily reports 


> eee from the veterinarians of all units. When two division veterina- 
y *. ¢ rians are on duty in one camp. each will report on his divisional 
“ - animals at that se and the senior. will in addi ion include the 
4 animals of other detached units. In the absence of a division 
q veterinarian, or officer acting aS such, the camp veterinarian 


a Tait ise 


tabi wif sie baneioesleh shat nitechte eons y 
fi ry ines Si a pc eye saalad bao se — 


Soyn thieise + wubed eiiaaiailacen srt prt tana ti psiahe inkl et ; 
| dsotit ens mine wl! Saetgise seht - hicevror, tive) fis an greece ia 
thine ett ner oO att ooh: basa ots tretectiog atte of © 

itabriat pains erieils Gerrans) doves onipelo nD HTD 
ae — son rat talitericn Abie Feoraaqet lao web: 


pay rite CH CERT epl se ae e NT coeic Ae pl ee 
= 4 ad Pg > ea acy ! Fi Tt . " 4 f 
soumwa rice, bE Ae NAT, fy M TB RO 2b St sorta ce: (ag 
"a ‘ FIND gs) 
i ea . apa 
; baie | Bo ee 
to pers | fat: YOK ALA, "10, EeiL et lye bs tO sarerinee saya} FQ Tere 
“ : : é 4 wn ; he den ee + nh 
; wae Ha 78 tt Aanitan tik ai! yates eh ez ffi ol iin wie wae i fic taae 
et es hey airs i T3597 delatr if ons Aigtelvib oil To CROP ARTE ERO. 01 0 oe 


eet al’ anit. “roger olf dart ag pi De toi) spat Teal BA fs Hated 
Ary. “Qyit ir Ji Sys gk YO hes shy way. piv et hava i iy or yet 
f OY aoe 05 wpe pies #4 pte ty ei me ~~ , og ee Det 

ae — ~ ee Bae via 


fies bes abi 5 “it? “fon i 
dss ta. pan 


. | wali ‘bal Harpe. 
Payolton * sito Of tp 

e O ‘Aas Petey ae 1 pi - ph rahe 

@ ‘tt Q19{ito Q's etd) 

rah ivih ait} sf alias Cpt 
daongat I merit lane ods olan #0 ie 
WATE MOF Tolls uly oy ae tz 
yas OK. oe is mes oe 


oo Semalhite ) Pi ) 1198 


4eu8 yeuaeeasts ine % tii woined ERP: 9 Dos 


Win} 


4 Saunt ony i, baa yeni at ¥1 by a | 

APH o 30, BH ROT 1G aol tficys 0 ¥ went: iow to 8 oat 

9 a hen FiaepniPen., adh | diel) Sa ig oil dorset gues 

. a ee ite 798, ei 1010) 8) Hoe 2 Snrouay) eA NM ia "ee 
ALB; iat Sidlietioges4 oat biad phate BAX 

pe pra O¥i ul sgonld , Jack worte Sito codtipes tig i 

*, oy ena marriott eiolite seclhpiate ity eoialy 


[S. R. No. 70, C. No. 1.] 


bo 


will furnish this information. This report will be made in 
duplicate, one copy retained and one forwarded direct to the 
Director of the Veterinary Corps, Office of the Surgeon General. 
The division veterinarian will also furnish the division sur- 
geon with a copy of the weekly report on Form 110, M. D., 
and with copies of any special reports from the meat and dairy 
inspector, and will forward the original in each case through 
the commanding general to the Director of the Veterinary 
Corps, Office of the Surgeon General. He will also furnish a 
daily numerical report of sick animals to the commanding gen- 
eral. (S. R. No. 70, C. No. 1, July 5, 1918.) 
[062.12, A. G. O.] 


20. Upon learning of the existence or suspected existence of 
a serious communicable disease among the animals in any of the 
organizations of the division, the division veterinarian will at 
once make an investigation and see that the proper action is 
taken to control and prevent the spread of infection. If the 
disease reported is glanders, he will recommend to the division 
commander the immediate quarantine of the animals of the 
unit in which it has developed or is suspected. His duties re- 
garding the conduct of this quarantine, the reports and recom- 
mendations to be made, and all other measures to be adopted 
by him in controlling the disease, as set forth in paragraph 55, 
will be strictly complied with. Similar action and reports are 
required in regard to other serious communicable diseases. 

The instructions in paragraph 52 regarding privately owned 
animals of contractors or others are equally applicable to such 
animals when admitted to the divisional area or other parts of , 
the camp outside the auxiliary remount depot, and the division 
veterinarian, as the senior veterinary officer present, will see 


that they are followed. (S. R. No. 70, C. No. 1, July 5, 1918.) 
7 [ger Be p AS Ge a 

. 5 Sih 708 Ais fAtorm himself of the efficiency, attention 
to el instruction, and equipment of all veterinary personnel 
attached to the division, and of the adequacy, serviceability, 
and proper use of veterinary supplies by means of frequent and 
thorough inspections. He will see that the responsible veteri- 
nary officers make timely requisitions for all equipment and 
supplies. He should hold them responsible for all shortages 
unless they can show that they have submitted requisitions in 
accordance with standing orders. Requisitions for veterinary 


See S.RI0. fow hy 235-24 


[S. R. No. 70, C. No, 1.] 
3 
supplies will be submitted to him in triplicate on Form 35, M. D. 
He will subject them to a careful scrutiny, seeing that they are 
prepared in accordance with authorized allowances and instruc- 
tions issued from time to time, and will make any changes 
deemed proper. He will personally verify, if necessary, the 
quantities reported on hand. He will refer all three copies to 
the division surgeon for approval. Two copies are then sent to 
the officer in charge of the camp medical supply depot for issue 
and one to the Surgeon General. In case of emergency he will 
request the division surgeon to authorize the camp medical sup- 
ply officer to make telegraphic requisition or purchase in open 
market. (S. R. No. 70, C. No. 1, July 5, 1918.) 
[062.12, A. G. O.] 

25. A veterinary officer attached to a mobile or other organi- 
zation will inspect daily the animals of his organization for 
symptoms of communicable or other diseases, injuries, evi- 
dences of error in feeding, watering, or stable management, and 
for faulty shoeing. He will investigate the sanitary condition 
of stables, corrals, picket lines, and other places occupied by the 
animals, of feeding and watering places, and of forage and 
forage storage. He will keep himself fully informed of all con- 
ditions concerning the animals of the unit, will promptly report 
to the immediate commanding officer any condition or practice 
observed which is affecting or is likely to affect the health or 
efficiency of the animals, and will make suitable recommenda- 
tion for correcting the defects. If any animal is found to be 
affected with a communicable disease of a serious nature, or 
exhibits symptoms suspicious of the same, it will be isolated at 
once and report of the condition made immediately to the com- 
manding officer and to the division veterinarian, the latter being 
notified by telephone or by special orderly. In case there is no 
division veterinarian present the camp veterinarian will be noti- 
fied. He will prepare a daily report on Form 102, M. D., * 
duplicate, retaining one copy and submitting one to the divi- 
sion veterinarian or to the camp veterinarian in camps having 
‘no divisional organization. The veterinarian of a detached 
command, camp, or post will not submit the daily report, but 
all unit veterinarians will furnish a daily numerical report of 
sick animals to the unit commander, (S. R. No. 70, C. No. 1, — 

July 5, 1918.) 
[062.12, A. G. O.] 


te 1 MST) : ia ‘, 


Veo ‘eist) 0 cide ‘ateotiah 1) ai gey tet wh hettiaidin, at HE 
“Wali tads guises aniinroe, (ihe 89.8 OF Cpe gee 
yceni baat {ngs | eta eX ee tased Lea fran tte ie slopes son elton 
eee AS, yet oolnen Hiw bes Sor ob ents; ae 
‘ bt peebie the. vitres ‘distemoy Uby oh Put 
adesotwerd condtediay velat (ive. o Bb oo iota: tie inner 
h, Of teoet aight. ol we asin owt tay eng: 20k cs NTS, 
| tel crohitodal iqane (nothom quiets at. to aR) wis 
Wher dit Qotepten@ ta cago kk, Cheapest) cient) ott ro 
dpavintiont qites ol? oaleiignn burr. tre ae ‘chee rin 
et oi Gumiistocn to oohthe igs pidyrreotad oxnnt oF 88 
| mt ele. SLAY 8 yl 1.0% 0.8% Ome a) 
1 ; ig {2 a ake 
“be ‘shoshten tO piidagy B03 fadoultk tome % canhydon, 
Mey in Uh LAE » wii So nba tie ost thats +979 adh 
1 ie. ani KE put og coal aot t® 493 eit! A poLiTe 


= 


trary | idote ate De heehee Jintie | inf 10% 
; 7 : 7) hare acai nye 4 dine ‘alt subi x fe a 
ce ie ancralty oii 10 bagel | fostaig alien Alda 

Rae Oe TO fois Ae MIG. wet aah hia w >» pi 
y saaseve bf ta barcsenint -etle't Tio hae yg Thy ot 
bag: ‘ et Gr PWriaie ee Th % 4 Te ee hi ty ef citi ond yer fie 
os “ a siege tA butte it “tquilld ws Ai nash arait 
abet, § eft toute oy vioatl af ae guithene #i dole 


i 
t 4 


‘ane “i Sonenceny 07 gidatine games Tbe bis eiotilae 2 oe 


a4 OT fy trot, Ot Inen tics Ae sf _wosivh oie autt ng 
bo as {t, anol, aR to hh » oldne Lat tingsro9 iy i 
‘A, hotale- Nod iiw 3h Bie a silt Yo) BioL Hata, erodgn 


Peis Si ad ‘tabi nit ola Oi bach at to 
qitod Aah a od? netimiiniay doielyib ay of Gita’ 
Ont, “t aed OR) m Sthetirtie fa 69qr yo ha “yout 
fot 6! Pipe Aah ay ase" fet RN ait jdiesiq as tise . 

it, ds we, BOL re co Pxoqoy, wiAb Bp Qi eany {thw 

a \ vera: off ‘al ie a him goo sao an bert ite 


hi begin i heated (TUBS 202 OF 70 fat aril 


tee 
Sar} 


fits 1b. PU ul aia aT) anol nisin iets Thad 
Bie: «Sta ont shah sod Tibve Howey 10 ine’ 
fay acsany whtite pe! the LTH ti up vite feist 
VAs SW Ok pak ebay CBI vey oil, oF 


LS. R. No. 70, C. No. 1.] 
4 


26. He will prescribe or apply treatment to those animals 
affected with minor ailments which are likely to respond 
quickly to treatment and which do not interfere with the mo- 
bility of the animal. All other sick or injured animals will be 
given such immediate attention as they may require and will 
then be reported to the: commanding officer for delivery to the 
mobile veterinary section for transfer to a hospital. An index 
card for hospital cases, Form 115, M. D., will be filled out as far 
as possible when each case is admitted to sick report, and the 
progress of the case will be recorded on the card in the manner 
described in paragraph 57. Any animal will be regarded as on 
sick report which is incapacitated for full duty by reason of 
physical disability. This will include animals in hospital, in 
convalescent corrals, and in sick lines, but not those isolated for 
observation or quarantined on account of exposure to infection, 
unless they develop symptoms of disease or injury or give a 
positive or doubtful reaction to a test for glanders. On the 
termination of the case by transfer of the.animal to a hospital 
in another command (by the mobile veterinary section or other- 
wise), return to duty, death or separation from the service, the 
ecard will be completed, signed by the veterinarian, and filed as 
a permanent record. If the animal is delivered to a mobile 
veterinary section or transferred to a hospital in another com- 
mand, a copy of the completed card, marked “ Transfer Card,” 
will accompany it to be delivered to the veterinarian of the 
place receiving the animal. If a descriptive card is received 
with the animal, the history of the animal will be copied on the 
hospital record, and when the case is terminated a notation of 
the date of receipt and discharge of the animal and the condi- 
tion for which it was treated will be made on the descriptive 
card which will accompany the animal if returned to duty or 
transferred. When animals are to be delivered to the mobile 
veterinary section the veterinarian of the unit will be responsible 
that a tag showing the number of the case and its organization 
is securely attached. Animals suffering severely from an in- 
curable condition shall be destroyed. (A. R. 1073, C. A. R. No. 
58, July 6,1917.) (S. R. No. 70, C. No. 1, July 5, 1918.) 

[062.12, A. 4 a 


ee er tenes 

en eriunn Ss are shipped directly from the place of pur- 
chase to organizations in a cantonment or post; the division 
veterinarian or other senior veterinary officer of the command 


[S. R. No. 70, C. No. 1.] 
5 


wil! supervise their reception. The procedure regarding quaran- 
tine and mallein testing laid down in paragraph 54 will be fol- 
lowed. The quarantine should be maintained in the organiza- 
tion receiving the animals. During the quarantine period the 
responsible veterinary officer will closely observe the animals 
for symptoms of any other communicable disease, and affected 
animals will be isolated in the organization, if practicable; other- 
wise they will be removed to the hospital or other suitable place 
where they will be maintained in quarantine until recovery and 
until quarantine requirements for possible infection with glan- 
ders are complied with. When animals are received under the 
provisions of this paragraph the veterinarian will prepare a re- 
port on Form 112, M. D. This report will be in triplicate, one 
copy retained and two forwarded to the division veterinarian, 
who will retain one and forward one through the commanding 
general to the Director of the Veterinary Corps, Office of the 
Surgeon General. 

When the animals of a unit are to be turned in to an auxiliary 
remount depot each one will be mallein-tested immediately he- 
fore being transferred or upon receipt at the depot. Reactors 


will be destroyed prompt promptly, and animals of an organization in 
which there are reactors will be regarded as suspects and quar- 
antined as described in paragraph 55. If practicable the quar- 
antine should be maintained in the organization, but the veteri- 
narian of the auxiliary remount depot will be consulted and 
fully informed of all circumstances. Any suspicious reactors 
must be plainly marked and described in such a way that their 
identity will not be lost, and they likewise will be kept in strict 
quarantine from all others until a report is received on the 
result .of the serological test. A careful examination must be 
made of all animals turned in to assure their freedom from any 
other communicable disease. Infected stables or corrals must 
be properly cleaned and disinfected as soon as possible after 
being vacated. The division veterinarian, or the officer acting 
- as such, as long as he remains in:camp will be responsible for 
earrying out these instructions. If directed by proper au- 
thority to leave before the animals are tested and turned over, 
he will transmit full information and instructions to the next 
officer responsible under these regulations. it all the veteri- 
narians of a division depart, the camp veter narian, if there be 
one, otherwise the veterinarian of the auxiliary remount depot, 


oe sp i Rathrency TL iy ont MOWING | shel . 
iy hed: ad iar te lags £ hag fil svboby hint vhifmat | aie 
e phe peiM ey ro Silt ei “bait et ey Sd Bluyorda silane 9 
ae hit TONS SAAR LNID “ait Prieta! elit ce ait 3 

: pinata, gilt siripeifo ¥foaols Iitw: qanifto qasainotay 
perosnk’ bes Twehoeih siimigammo tito yith 20% Fu 

, Tithe 1 oyhit sof fy tery ¥ rt a pont ih [ hontard od ive al Gi 


- 


t La 
ane: i fy ‘oldntiie etltG ‘to rare oft oi D TOUR 6d if 
‘ . f Ni yy 
hate Pog y chet ives & maup af beats tif pet od ns 
CUNT a 


rh a ate hoa tte pa te tot ay ate iiotepe ons 
asl’ esi 0ns) navfasax ott einotina aotW yi an "i bail! ‘i009, 3 

at i ALN Te he astra tress at} ist pyres gists 8 : as 
OS ataotigit? Abad Hin Pq PmaT =. we pt yt " 
er etare7 nota oi OF DoOlitt avo ow bas rene 
sist berm ste att Weworty sri pen ot bate See alas ath 
ante 46 GU oi) WRONG Y “on) to _10F ven od 


4 7 
Lathes sg ag aval beg cut ent (4 Rete Jigtt ato 
Fey cai giadsiloans ch DARA Ta Aiea Mea dines ‘ 
hegltas Th fb ae 9. is ryan ; “8 ie r Py 
uty BON ously ih A byt la oe 
ii io wala nal fe To ein Sa ligt 1 Deo as 
ne Pie stanieue ea hetringes vif Mh vr ‘ano tonet ait t 


Ory 

erry hal Whdarif wut 1 (yeni rat if ‘bedi scala 

y Liane Aa y ry 
‘hear one 4p ‘qobhasiiesto OM) ee ben liek, je 
pigpar evs Haines eet Thee Veh JOHOMEN cipiiiens | oft 3 


aii: i Winey Site ak, 'e) Hp SME ‘lid 10. bane 
apart) peers a st ‘fore ni Dew ian Ltt A Reh : 
gel what wit tie ‘Yook ad ot a 


ype ge’ ert yee of ul f ti cs 
Lane tovtator'al bois 9 titer Bolte it ie ai 
Rtiae get pa Patt pres Pe tae Picrteian ke yer ‘Tesehotia Oe 
My ay: tae ite noe atthe ee ba ‘ifs tee 3 OF fel Hones agi , 


se tae OTRAS TE) pit CRYe 1) si i se oval » ie 


bee, “ot aie “dat iti ee ag iid iy beer et ity Dis ere) 
x int: a ee ite ait? a0 Whetiuiiiwruy, worivil: ad tv bate 

nit Nuts dopa ode gre quits al vathitaat on 2a hibit 
ud ter yeti 4)” edit sHowataier “gay”: 1H 
Lite t fvadect yt MART So ott? wtcted aragt . 


“te: TONY 
4 “ets ‘Meyet ert 
geernonrel frie siete 


Siew wit wd earl omtedtl hits oi 
sf poolistute: sasdt wolves ol diaries 


AN fie App. ity itn ers 
Ray adtatoty AQ cual salreter qerno: lg iret cael S, nie 
mi ng 178 sasnieeti — moet) he eight crews torr act og ras 
i Masa lplal i anh ud oo ae , Yer 4 ty: a ee abs oh Kage 
7h Wey } 
; | Yea 


[S. R. No. 70, C. No. 1.] 
6 


will be responsible for compliance with the foregoing instruc- 
tions. It is necessary that division or other veterinarians co- 
operate fully with the veterinarians of auxiliary remount depots 
in these measures to secure satisfactory results. (S. R. No. 70, 
C. No. 1, July 34, Hee) 
[062.12, A. G. O.] 

> 45>: Te & Ferien ae commander the veterinarian of an acetate 
zation, command, or post is responsible for the care, discipline, 
instruction, equipment, and assignment to duty of his men, and 
the adequacy, serviceability, and proper use of all supplies and 
equipment. Requisitions for veterinary supplies will be made in 
quadruplicate on Form 35, M. D. Three copies will be presented 
to the division veterinarian or to the camp veterinarian in camps 
having no divisional organization, and one retained. Requisi- 
tions for quartermaster and ordnance supplies will be made on 
the proper supply oe (S. R. No. 70, C. No. 1, July 5, 1918.) 

[062.12, A. G. 

Seg. Sih 244d P Paws l Sheer in charge of the mobile veterinary 
section will bear the same relation to the division veterinarian 
as now exists under the regulations and the customs of the serv- 
ice between the commanding .officer of the sanitary train and the 
division surgeon. He will issue a receipt to the responsible 
officer for all sick animals received, and will be responsible for 
the care and treatment of such animals until they are returned 
to the organization or evacuated to a base or other veterinary 
hospital. On delivering them to a hospital he will take a re- 
ceipt from the veterinary officer in charge. Upon returning an 
animal to its organization he will take a receipt from ‘the re- 
sponsible officer. These receipts will be made out on Form 116, 
M. D. A copy of Form 115, M. D., completed as a transfer card 
by the unit or other veterinarian, should accompany each sick 
animal taken over by the mobile section. An exact copy of this 
card will be made down to the signature, and if no card accom- 
panies the animal an original one must be prepared. On the 
reverse of both original and duplicate will be noted date of re- 
ceipt of the animal, date and nature of changes in diagnoses, 
complications, special treatment, and other data necessary to 
make a continuous clinical record of the case while it remains 
in the section. The cards for animals received by a mobile sec- 
tion will be numbered consecutively from 1 upward, and both 
copies of the card will be given the same serial number; also 


° 


od [S. R. No. 70, C. No. 1.) 
7 


the number of the section and the division to which it pertains. 
_ On the transfer of the animal to a veterinary hospital, the dupli- 
eate copy will be completed by the signature of the veterinarian 
in charge, dated, marked “ Transfer Card,” and forwarded to 
the receiving veterinarian. The original transfer card is likewise 
completed by signature and placed in the permanent file of the 
section. Should the animal be disposed of in any other way 
than transferred sick, both copies of the card after completion, 
with suitable notation as to the disposition, are retained. (S. R. 
No. 70, C. No. 1, July 5, 1918.) 


[062.12, A. G. Ba 
SesS.R.70 Fax 54. 
a. As the ose eee an of a mobile organization, he will sub- 


mit to the division veterinarian the daily report on Form 102, 
M. D., required by paragraph 25. This report will include only 
animals permanently assigned to his unit. On each Friday he 
will make a report to the division veterinarian on Form 102, 
M. D. (modified), for the week ending at noon of that day, as 
regards animals temporarily in his charge. This report will 
show the number of animals on hand, the number received dur- 
ing the week, and the number returned to organizations from 
which the animals were received, and the diagnosis of the dis- 
ease or injury in each case. This information should be com- 
piled from the retained transfer cards (Form 115, M. D.) on 
file in the section. Under remarks will appear a résumé of the 
work of the section for the week. (S. R. No. 70, C. No. 1, July 5, 
1918.) 


S ek Re. A. G. O. un 
te 70 fo 
37. As a unit MO fhe | is responsible for the care, dis- 


cipline., instruction, equipment, and assignment to duty of his 
men and for the adequacy, serviceability, and proper use of all 
supplies and equipment. Requisitions for veterinary supplies 
will be made in quadruplicate on Form 35, M. D. Three copies 
will be presented to the division veterinarian and one retained. 
Requisitions for quartermaster and ordnance equipment will 
be made on the proper supply officers. (S. R. No. 70, C. No. 1, 
July 5, 1918.) 
[062.12, A. G. O.] 
See S.R. 76 fox Pan Sh-59-F9-F/ 
AUXILIARY REMOUNT DEPOTS. 

42. The senior veterinary officer assigned to an auxiliary re- 

mount depot will be designated as the veterinarian. Under 


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[S. R. No. 70, C. No. 1.] 
8 


the commanding ‘officer of the depot he is in charge of the 
peer ineey, service thereot and. will_assisu the oficers and mep 
of hi : ies. (S. R. No, 70, C. 
No. 1, July 5, 1918.) 


[062.12, A. G. O.] 
See SR. 76 for Pe g5-t7. 
45. He will be in charge of the veterinary hospital, operating 


room, convalescent corrals, and other places for the care of 
sick or injured animals. He will be responsible for the efficient 
organization and administration of the hospital service, for the 
cleanliness and sanitation of all parts of the hospital, and for 
the preparation of the required reports and records. (S. R. NO. 
70, C. No. 1, July 5, 1918.) 

[062.12, A. G. O.] 


/ 46. He will be responsible that the authorized allowances of 


J, veterinary supplies and equipment are on hand at all times; that 


/ 


they are in a serviceable condition; and that care and economy 
are exercised in their expenditure or use by all concerned. He 
will prepare requisitions for veterinary supplies in quad- 
ruplicate on Form 35, M. D. These requisitions will be made 
out in compliance with existing orders, three copies submitted 
to the division surgeon and one retained. In the absence of a 
division surgeon, the camp surgeon will act on veterinary requi- 
sitions, After receiving the approval of the division surgeon, 
two copies of the requisition are sent to the officer in charge of 
the camp medical supply depot for issue and one to the Surgeon 
General. In case of emergency the veterinarian will request 
the division surgeon to authorize the camp medical supply 
officer to make telegraphic requisition or purchase in open mar- 
ket. Requisitions for quartermaster and ordnance supplies will 
be made on the proper. supply officers. (S. R. No. 70, C. No. 1, 
July 5, 1918.) 
(062.12, A. G. O.] 


4%. He will supervise the sanitation of the depot in all mat- 
ters affecting the health and efficiency of the animals, and will 
be responsible that suitable recommendations for the correction 
of sanitary defects are made promptly to the commanding officer. 
These results are best accomplished by frequent and thorough 
inspection of all parts of the depot occupied by animals, including 
the forage and storage of the same. (S. R. No. 70, C. No. 1, 


_ duly 5, 1918.) 


(062.12, A. G. O.] 


[S. R. No. 70, C. No. 1.] 
9 


48. He will make a daily inspection of the entire hospital, 
paying special attention to cleanliness, sanitation, and the care 
and treatment given sick animals. The presence of the junior 
veterinary officers at inspections should be required either at 
their posts of duty or to accompany the inspecting officer for 
purposes of instruction. (S. R. No. 70, C. No. 1, July 5, 1918.) 

[062.12, A. G. O.] 


di . . . oti . . * : 
of all_enlisted men of the Veterinary Corps at the depot, He 
will be responsible that all veterinary officers are properly _in- 


structed with regard to their profession nili i 
and _responsibilities, (S. R. No. 70, 0. No. 1, July 5, 1918.) 
[062.12, A. G. O.] 


50. He will make monthly reports on Forms 111, M. D., and 
ATA, M. D., in duplicate, retaining one copy and forwarding one 
direct to the Director of the Veterinary Corps, Office of the 
Surgeon General. (S. R. No. 70, C. No. 1, July 5, 1918.) 

[062.12, A. G. O.] 


51. He will make suitable recommendations to the command- 
ing officer as to the best method of disposing of animal carcasses 
and will supervise the operation of the plan adopted. Contracts 
with civilians for the disposal of dead animals should specify. 
removal without delay on receipt of notification. If the car- 
casses are to be burned or buried by the military authorities, 
the work will be done with all possible expedition and under 
sanitary precautions. Animals in severe pain from an incurable 
condition and those found to be affected with glanders will be 
immediately destroyed. No animal with positive signs of glan- 
ders will be held for further testing, nor will those reacting 
positively to the mallein test be held for further test of any 
kind. Other sick or injured animals which are not likely to 
again become serviceable will be disposed of according to Army 
Regulations. (Par. 1073, as amended by C. A. R. No. 58, July 
6, 1917.) (S. R. No. 70, C. No. 1, July 5, 1918.) 

[062.12, A. G. O.] 


52. The veterinarian will advise the commanding officer in 
regard to the prevention of disease among the animals at the 
depot, and especially in regard to the control of communicable 
diseases. Animals owned by contractors or other private par- 

74163°—18——_2 


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[S. R. No. 70, C. No. 1.] 
10 


ties, whether or not stabled in the depot and allowed therein 
‘for any purpose, will be subject to the same inspection by the 
veterinarian as are public animals. Evidence will be required 
of their freedom from glanders or other communicable disease. 
When the application of the mallein test to such animals is 
deemed advisable by the veterinarian, he will so report to the 
commanding officer; and should the owner refuse to consent to 
their being tested they should be wholly excluded from the depot. 
In the same way cases of glanders or other suspects may be ex- 
cluded. If a case of glanders is discovered amongst such ani- 
mals while they are at the depot, the procedure as regards 
quarantine, mallein, and other testing and the destruction of 
infected animals will be the same as for an infected corral or 
organization of public animals. This provision should be ex- 
plained fully to private owners and their agreement thereto 
exacted before the introduction of their animals into the depot 
area is permitted. (S. R. No. 70, C. No. 1, July 5, 1918.) 
§ 2d ORY, Pow Pan se5 

54. Upon receipt of animals from any source whatsoever they 
will all be examined carefully by a veterinary officer, and if in 
ears will be promptly unloaded. ‘The sick will be sent to the 
hospital, the others placed in isolation paddocks apart from 
other animals, and the ophthalmic mallein test for glanders ad- 
ministered to both sick and well at the earliest practicable date. 
Those giving a positive reaction will be destroyed at once, and all 
apparently healthy animals of a shipment in which there were 
any reactors will be retested after 21 days from the date of 
the last test by which reactors were found. It is contemplated, 
in other words, to hold each such lot of animals in quarantine, 
applying successive tests at intervals of three weeks, until a test 
is made which yields no positive or doubtful reactions. When 
the result of any of the tests is indefinite or suspicious, the ani- 
mal will be separated from all other animals, the test will be 
repeated, and a specimen of blood drawn and forwarded to the 
nearest laboratory where provision has been made for making 
the complement fixation and agglutination tests for glanders. 
If either the mallein retest or the blood test is positive, the ani- 
mal will be destroyed at once. A post-mortem examination will 
be made of all animals destroyed which failed to show physical 
signs before death, and the report of the findings filed with the 
retained records of the veterinarian. Carcasses of animals de- 


‘[S. R. No. 70, C. No. 1.] 
TL 


stroyed for glanders will be removed promptly from the vicinity 
of other animals. They may be disposed of to contractors or 
they will be burned or buried with proper sanitary precautions. 
Contractors will be warned against danger of possible infection 
in handling carcasses of glandered animals. 

All_ animals should be tested for glanders before they leave 
an_auxiliary remount depot, and if the ophthalmic mallein test 
has been previously applied twice, a third test should not be 
administered until 21 days after the application of the second 
test. If, on account of military necessity, any ‘animals are issued 
without being tested, a report will be made showing their num- 

7) ber and kind and the designation and location of the organiza- 
tion to which they are sent. This report will be in duplicate 
and forwarded through military channels, one copy to the com- 
manding officer of the division, detached organization, or depot, 
to which the animals are shipped and the other copy to the 
Director of the Veterinary Corps, Office of the Surgeon General. ) 

Whenever, by any of the approved methods, a diagnosis of 
glanders is made in a shipment or other lot of animals received 
from any source, whether within the camp or outside of it, the 
veterinarian will immediately notify verbally or by message, 
confirmed the same day by letter, the veterinarian of the com- 
mand from which the animals came. This should be the division 
veterinarian or one acting as such in the case of a divisionai 
unit. If the case is the first oné from the organization, or if a \ 
new case is at any time discovered amongst the animals in a 
depot, a telegraphic report of the facts will be made to the Direc- 
tor of the Veterinary Corps, Office of the Surgeon General, and 
stating that the veterinarian of the issuing unit has been noti- 
fied as above instructed. (S. R. No. 70, C. No. 1, July 5, 1918.) 

[062.12, A. G. O.] 


© - 55. On the discovery of glanders all other animals in the lot, 
shipment, organization, corral, stable, or other place in which 
the case was found will be regarded as contacts. and immediate 
steps taken to prevent their coming in contact in any way with 
clean animals elsewhere. If the case has developed in a mobile 
unit, all the animals in that unit will be considered contacts. 
The suspected animals will be segregated in a clean corral or 
stable, and the corral or stable in which the case was discovered 
will be disinfected. Fences, stalls, floors, partitions, feed boxes, 
and watering troughs and stable utensils will be cleaned of all 


ay a , . 
ou Br Gr Or z By. 


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a ett per}a02 ot to. ‘horogeth ad Yam’ ott Bry: ‘ft ti 
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fol! ptact old teeny, tO weet) Bente ss bore “Sa tive Ge 
weak gegen tT s, Here er nie te degen a ‘1 thie 


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jean. aie alae spiral ash easy Sit i, Dag. 1h quae 8 
od. tom, biuorin (a. 42a). Hiield. B ‘give pniga eetoke 
Danae. aid, ee goltnailade. atl. ROMAN As rth. FS, 
(rupert own alaen last Tis, CHAE veal eres) day 10 308 
‘ x jrersh, Tig Rial woe? Shain ia tity a 3. nt ge haters Yak ; 
prays ad ta fal Lia! Fite iol yee of ot pate fi aa 


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i. 


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pay f bite aly Klan eyed Feo ie fis AOA ott a’ “ay waa 
j ry Pera ae Gd Biideret ae (io? e2 i Cae | eet hdd ; 
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[S. R. No. 70, C. No. 1.] 
12 


loose dirt, scrubbed with soap and water, and sprayed with 2 
per cent aqueous solution of the cresol compound, issued by the 
Medical Department. Infected forage and bedding will be de- 
stroyed. 'The suspected animals will be fed invariably and 
watered usually at their corral. Should occasion arise to water 
elsewhere, buckets will be carried and used exclusively for this 
purpose and access to watering troughs elsewhere prohibited. 
Sick animals will not be removed to any other place for treat: 
ment. All contacts will be given the mallein test. Retesting in 
21 days and complement fixation tests will be done as set forth 
in paragraph 54. The quarantine will not be raised until a clean 
test has proved presumptively that all the animals are free from 
glanders. Upon being released from quarantine the animals will 
be turned into clean quarters and the corral or stable in which 
they have been kept will again be cleaned and disinfected as 
already described, irrespective of whether any cases of glanders 
have developed during the quarantine period. 

The veterinarian is responsible for the early detection of glan- 
ders and for proper recommendations to the commanding officer 
regarding the institution of the quarantine measures prescribed 
herein. Should he deem the quarantine of the entire depot ad- 
visable he should so state. He will advise when the quarantine 
should be removed. These recommendations should ordinarily 
be in writing. He should supervise the operation of the quaran- 
tine and make sure that its provisions are fully and conscien- 
tiously carried out by all concerned. From the discovery of the 
first case to the time when a clean test has been made and the 
animals have been released from quarantine, he will report 
weekly in writing to the Director of the Veterinary Corps, Office 
of the Surgeon General, through military channels. This report 
will cover the measures adopted to control the disease, the effi- 
cacy of the quarantine, reasons for its failure in any respect, 
the progress of the disease, numbers tested and kinds of test, 
number destroyed, and any other information pertaining to the 
epidemic. All recommendations made to the commanding officer 
and the action taken thereon will likewise be included in this 
report. (S. R. No. 70, C. No. 1, July 5, 1918.) 

[062.13, A. G. O.] 


56. When animals are shipped from a remount depot they 
will receive a careful examination under the supervision of the 
veterinarian to detect communicable disease and eliminate the 


[S. R. No. 70, C. No. 1.] 
13 


sick. Stock cars submitted for their transportation are re- 
quired to be cleaned by the railroads of manure and loose litter 
and placed in a safe condition, but not disinfected. The rail- 
road will also furnish bedding, which will not be placed in the 
cars until they have been cleaned and disinfected. The veteri- ~ 
narian will examine the cars on their arrival and will determine x» 
the extent and necessity of further cleaning and disinfecting, ~ 
and will supervise this work, notifying the commanding officer 
when the cars are ready to receive bedding and to be loaded. u 
The veterinarian will also make a report on Form 101, M. Bas 
covering the shipment. This report will be prepared in tripli- 
cate as far as the first asterisk, two copies sent direct to the 
veterinarian of the organization receiving the animals, and one 
retained. The receiving veterinarian will complete his copies, 
retain one, and forward one, through the division veterinarian, 


to the Director of the Veterinary Corps, Office of the Surgeon 


Jon Fownis VOl% Ia 


ea 


General./The veterinarian of a command will also fully in- 
struct in their duties all veterinary personnel accompanying 
shipments of animals. A veterinary officer assigned to this duty 
will, upon its completion, submit a detailed report of the jour- 
ney to the Director of the Veterinary Corps, Office of the Sur- 
geon General, through military channels. This report will 
show number and kind of animals; time required to load; suit- 
ability and cleanliness of the cars provided; date and hour of 
departure, of arrival and departure at each feeding station, 
and of arrival at destination; description of feeding and water- 
ing facilities and other conditions encountered en route; sani- 
tation, adequacy, and suitability of yards provided; kind and 
quality of forage used, reasons for and duration of delays en 
route; names of all attendants; complete data regarding any 
’ sickness or deaths amongst the animals and their condition on 
arrival. Should sick animals be left en route, the diagnosis 
and the name of the individual with whom thus left should be 
etared.. (8S. Rk. No. 70, C. No. 1; July 5; 1918.) 
[062.12, A. G. O.] 


57. He will see that an accurate clinical record of all cases is 
kept on the index card for hospital cases, Form 115, M.D. A 
card will be made out for each animal on admission to sick 
report, the cards being numbered consecutively. Any animal 
will be regarded as on sick report which is incapacitated for 
full duty by reason of physical disability. This will include 


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¥ Be Chitin oabis: iw Dee ve Cit fee 

Panthers ah 1 aa ite “ata eer ry 
tee eeiisieh Y Sey | i +¥ eS - (sitive ti: ay 


fore). (ASshaae  & 3 ith A itt anf ai ' 


mAh) : jot t nt 3 bia) 1645 se 


a BPN os é 
; + 
ory id ‘ 1 ~a/ 
Te! Bey ei anety © ila t “Hedave 
; ' gh le 
Hoot Sars Re G terfa LAE RS 
Hh THB rr serif 
(heat oa Te fairs 
: & BOThoot- to ttalhgtie eat ue wie co 
i sti e Loortl 
’ palate hig see 2 
ib eer aa | ; ' ‘ this “ching 
fe Tis Pe eee et oral ; ch a 
PO A COOTER BESS Sty GOOF  Btero tihietif “Tt 


ier ig Sa Lt a) nit Tee sees Ces ae uy 
ae) | treet cers: Thats thtnge alias Uitte Bild SRA ci ee 


"ee co by ti “tag iy" onihy mitt et We THE i wiamitit foie 
i vane his rhe fal ele wot: lilies PART d BR ott Ve 
He eM Ray ig wc as ER LAT, Cheth WR ae 
5 an be ial 1 ea fee 


3 ey penn? ile. to bien: La! pity sigue oii dt oot Hie 
“ i fe oft MG dg leh Boe: legaual oR bth! > ¥abat 
hy Aye at, note » Peeet EE CU fhiti Pereny ‘dew : ae 11 : - ahs 0 we 
Mt bide rete HLA Pee A nerdy mt pe, wo 
Act fe)! rf i EAE} raat Hy date ‘nth roa e8 oe 


Soin ie en hah 


. [S. R. No. 70, C. No. 1.] 
14 


animals in hospital, in convalescent corrals, and in sick lines, 
but not those isolated for observation or quarantined on account 
of exposure to infection, unless they develop symptoms of disease 
or injury tr give“? pe™tive or doubtful reaction to a test for 
glanders. The blank spaces on the front of the card will be 
carefully filled out as far as possible when the animal is placed © 
under treatment, the corral, ward, or stable, and the number 
of stall also being entered for convenience in locating the animal. 
The progress of the cases will be shown by proper entries on 
the back of the card, giving the dates and nature of treatment 
and changes therein, date and character of operative measures 
applied, date and nature of complications and sequels, and any 
other data bearing on the history of the case or the future use- 
fulness of the animal. For most cases brief entries will suffice, 
but when the case is unusual or likely to be of scientific interest 
the data should be recorded in more detail. In recording diag- 
noses and complications the official nomenclature will be adhered 
to. On the termination of the case by return to full duty, death, 
separation from the service, or transfer to a hospital elsewhere 
the card will be completed, signed by the veterinarian in charge, 
and filed as a permanent record of the hospital. When an 
animal is transferred from an organization or hospital to another 
hospital a copy of the completed card marked “ Transfer Card ” 
will accompany him to be turned over to the veterinarian of 
the place receiving the animal. If a descriptive card is re- 
-ceived with the animal the history of the animal will be copied 
on the hospital record card, and when the case is terminated a 
notation of the date of the receipt and discharge of the animal 
and the condition for which it was treated will be made on the 
descriptive card, which will accompany the animal if returned 
to duty or transferred. (S. R. No. 70, C. No. 1, July 5, 1918.) 
(062.12, A. G. O.] ; 

58. The veterinarian will also prepare reports on Form 102, 
M. D., covering the week ending at noon of each Friday. One 
report will be made for animals in the hospital only, and the 
other for the remainder of the depot. These reports will be 
made in duplicate, one copy retained and one forwarded direct 
to the Director of the Veterinary Corps, Office of the Surgeon 
General. He will also submit a daily numerical report of sick 
animals to the comanding officer. (S. R. No. 70, C. No. 1, July 5, 


1918.) 
[062.12, A. G. O.] 


[S. R. No. 70, C. No. 1.] 


15 
59. He will also report the arrival of each shipment of ani- 
mals received at the depot on Form 112, M. D. This report will 
te be in duplicate, one cop J j t arent 
” @&the—Feterirary Corps, OHiBK-f fire 3 Oi 
(tL 4 military_channels. fee a turned in from any organization 
will be similarly ilarly reported 0 on this form. "te. fe. No. 70, ©. No. in 


July 3, 1918-5” mniomnmnarinmmnemmenn SCC A21SO Ci¥evlav letter # 
[062.12, A. G. oO. ] 
rt pee BO) fon Pax ge samaae ZONE. 
61. The senior veterinary officer assigned to the headquarters 
of a purchasing zone will be designated as the purchasing zone 
7) veterinarian. He will report to the officer in charge and act as 
: his veterinary adviser in all matters involving the purchase and 
transportation of animals. He will maintain an office at the 
zone headquarters and will not be assigned to duty with a pur- 
chasing board except in an emergency. (NS. R. No. 70, C. No. 1, 
July 5, 1918.) 
[062.12, A. G. O.] 


62. Under the officer in charge he will assign veterinary 
officers to purchasing boards or to other ‘appropriate duties ; will 
see that they are fully instructed as to these duties; and will 
supervise the work of all veterinarians detailed to the zone. As 
a detachment commander he will be responsible for the care, 
discipline, instruction, equipment, and assignment to duty of 
enlisted men of the Veterinary Corps stationed in the zone. 
(S. R. No. 70, C. No. 1, July 5, 1918.) 

[062.12, A. G. O.] 


63. He will also supervise the care of public animals which 
may be sick or disabled. If a hospital is available at head- 
quarters of the zone or elsewhere he will be in charge of it and 

®© responsible for its administration, the care of the animals, and 
the assignment to duty therein of any available assistants. 
The records and reports will be the same as for other veterinary 
hospitals. He will submit the weekly reports on Form 102, M. D., 
as required by paragraph 58, from the veterinarian of an auxil- 
iary remount depot.. A separate hospital report will not be re- 
quired unless animals are received from organizations. He 
will be responsible for the adequacy, serviceability, and proper 
use of veterinary supplies or equipment. Veterinary supplies 


Ge Ie! RN AL Oe eae ai 9 vr i a 


jah ace aT od eS At 1 oe reo LA om : 


hy Se cued Hyg (ies Pigs, (Gilgwent os cop. A a paly tae 


ne) {8 Eby t: sth 9 OKs yy on ivy 
S07 sD re OqghiSs il 0 
We PREEIOWZGO Ble Oh 


roe pel shi bir Ae tea 


Rei? BHP to: Ves WOH: at wet 


fh wp 


, > Geer 
‘ 
; : * { } a? h det i 
‘ 1“ 
» re 
ot en Perel peut ri At ef re i PY yh 3 “ye t 
uptis 
PUN : ri : Co ehale ek Faas Ce Lh: 
4 } $ 4 
wi H 7 7 $ Tee) : - eee | f ; {7 
ii as ‘ ¥ r fy iB ra Cao ed ee 
a | a »* * 
" Pa S : se 


aly oii (ants 


¢ 
We ap Ba Ay “aise “9 gears 
rE ke 3 be “8 : - é 
‘ad a : 
RAN THY t + ~ 
‘ } . 
i - i é ; 


Te Te Bis DF Ma ay 
Wey, ee 4 fet ti, of Tie aa ofutundios ib 
ROO? REE Oa TOG ‘ Ti apegigbty : “Bo GMs Hara be 


CM EL ioe aa ‘Yo wt 
nt 

dviehice, mh “sd 7 

fy cheek ot ke kelp ; 

yurtiR } he ae ii i. tt 4 

tietay orwiet wars rEeM pede t 


Aisiiontsclee Sas occnan.ho,ctraenaaeaae oa 
“Miss tertia tet en curay, edt. of Mite eto: ae treme 
JE SOF wok. wo ehier ets alae pees tirnetiere bee oP 


ixmaciiy! te antientetos Ady ast BO heey ie ee ede 


hn ito tae era toy | ans?) ari gedt ATR, elmore 
scent hagig itiina vie sopake St tot pidlaaae 
a ay Lepage MRIIOTS if.  Jrearqinpe mM) voltan ill YR 

we eee ae : fer 


" Rey h te > 


[S. R. No. 70, C. No. 1.] 
16 


will be obtained on requisition Form 385, M. D., prepared in 
quadruplicate. Three copies will be sent direct to the Director 
of the Veterinary Corps, Office of the Surgeon General, and one 
retained. In case of emergency he is authorized to make request 
by wire, but he should foresee his needs and obviate this neces- 
sity. (S. R. No. 70, C. No. 1, July 5, 1918.) 

[062.12, A. G. O.] 

64. He will also supervise the sanitary conditions which are 
involved in the purchase and transportation of animals in or 
through the zone. He will thoroughly familiarize himself with 
local conditions bearing on the health of animals and will keep 
in close touch with the work of civilian inspectors who report 
to the officer in charge of the zone. To enable him to properly 
perform these duties he should, when necessary, visit places 
where inspectors or purchasing boards are at work. (S. R. No. 
70, O. No. 1, July 5, 1918.) 

[062.12, A. G. O.] 

65. He will report unsanitary conditions verbally or in writing 
to the officer in charge and make recommendations with regard 
to the correction of the same. Written sanitary reports will 
be submitted to the officer in charge and forwarded through 
military channels to the War Department. (S. R. No. 70, C. No. 
1, July 5, 1918.) 

[062.12, A. G.0.] 

66. He will prepare monthly reports on Form 111, M. D., and 
47A, M. D., in duplicate, forwarding one copy direct to the 
Director of the Veterinary Corps, Office of the Surgeon General, 
and retaining one. (S. R. No. 70, C. No. 1, July 5, 1918.) 

[062.12, A. G. O.] 

67. Veterinary officers assigned to purchasing boards will 
report direct to the officer in charge and act as his advisers in 
all veterinary matters. When more than one veterinarian is 
assigned to the same board the senior will act as the veteri- 
narian in accordance with the customs of the service. In the 
performance of their professional duties they are under the 
supervision of the zone veterinarian. In the inspection of ani- 
mals for purchase they are responsible for the detection of 
physical defects and evidence of disease. Whenever animals 
are collected for purchase or shipment they will investigate the 
sanitary condition of the yards or stables and will recommend 
to the purchasing officer proper measures to correct defects. 


6 


[S. R. No. 70, C. No. 1.] 
17 


They will apply the mallein test to all animals before they are 
shipped. Great care will be exercised in the inspection of ani- 


mals and the use of the test in order to eliminate positive or. 


doubtful reactors, and on the discovery of such, all other ani- 
mals from the same lot or stable will be regarded as contacts 
subject to quarantine and retesting as provided in paragraphs 
54 and 55. Whenever it is impracticable to quarantine at pur- 
chasing points or at zone headquarters the contacts will be 
shipped as a separate lot and will be accompanied by a full 
written statement from the senior veterinary officer of the 
board for the information and guidance of the veterinarian at 
the destination of the animals. The zone veterinarian, the State 
veterinarian, and the local representative of the Bureau of Ani- 
mal Industry, if there is one, will be notified at once on the 
discovery of a positive or suspicious reactor, and all veter- 
inarians attached to boards will cooperate fully with the local 
live-stock sanitary authorities in every effort to limit the ex- 
tension of infection. (S. R. No. 70, C. No. 1, July 5, 1918.) 
(062.12, A. G. O.] 


68. A veterinary officer assigned to a purchasing board will 
report on each lot of animals which he has inspected on Form 
109, M. D. This report will be made in triplicate, one copy re- 
tained and two forwarded to the zone veterinarian who will 
complete them both, retain one and forward one through the 
- officer in charge to the Director of the Veterinary Corys, Office 
of the Surgeon General. (S. R. No. 70, C. No. 1, July 5, 1918.) 

[062.12, A. G. O.] 


69. Reports will likewise be made of any undesirable sanitary 
conditions to which animals may have been exposed either be- 
fore, during, or after inspection, which, with suitable recom- 
mendations, will be submitted to the officer in charge and for- 
warded: through channels to the Director of the Veterinary 
Corps, Office of the Surgeon General. (S. BR. No. 70, C. No. 1, 


July 5, 1918.) 
[062.12, A. G. O.] 


PORTS OF EMBARKATION, 


70. The senior veterinary officer detailed to a port of em- 
barkation will be designated as port veterinarian. He will 
report directly to the commanding general and will act as his 


by enaceegel. af maa lates, Ape eed GAT (nie ‘se ont pes «ie 


a) tolven gb peed oat 1 foe 
y vroyoutie dd ao yb ais evo 
at. Hive okfate to tol, Si ne kt miko 
buriq, aera ridegiet bas. paitsiner tt xp 
t shiaubomupett ab ot qevenod ve 

ta Pe MAO SB Spee actinl 
a! Uwe Chis thet adie Sacto fk, a 
ditt tor ite Prise! Teles OF cyan rao tale ? 


ty PAA ; onan bat PR SLTCLS Oey erty h ugh ra) 
94 oat? AREA gy anan.e'Ehe “het ont pian 
aELBS Ye i isi fo tee apy bt etis viet Pnecol stt Lega . 
Hit enone db. batt ipck ed Nie deh wid hs 
; a fei. ESRB ot \ wae. aby tRNA, wd orien git! 
- Spocdatt itu. steraqoos fia ei nad of i “io etya 
| ce -apekas tag By eet Tt, eToys el sali iodtictie wnat 3 rode 
se eh pha: oe if SS. avid *\ P oa At we Aso 4 : 
fe i . in +e ae PT ft hd he ra 
PR Ve ee NT ce fever feat iain eight ste 
ol APTOS REE | . Bris nlf oS SETA PR a ie) ie 
fs Soles Art sities ar oben 6a vege #8 done npr BHT f 
“I Breiee Ani ried mos oii i te yaw ot -owrt) ‘bie 
k at peta ever’ bag ee Apts ind 7s 
; Has Hire tede Y alia soieage = oboe arte 


i vad ‘ eat Tt Ue } L ny YY Me ah atu i 
TAs ae : , Gop. RE wo ue 


‘ as \, y i r i 

y } er Pe sean ES Tae ie 

ae “f s t at ee 

ev rf OPT ER is vent) fat f 

ay) Tes 13 i cabs s { ; 

on Mog Ts vF Fe 

4 Arnis 
F 
wt A Poy beer Stas Pee 
7 . 
ae " 

+92 
. ‘ f 
7 * a. ty 

Wate : 
’ . 

‘“ ‘ 

ie ' 
; '¥, | £ ws Lat 

: ei eae a7 wae 

a Mi i 
: ‘eis 

r : Seat ; } . 

AL ot aff 4 4 ha ale ‘ 
aay “8 = te , f ‘ : . b “yh ne Se 
“(ia ret PEROT] , ‘ teil i! dai? 1 rye Cie {ti 4! ‘) r CS 2 

‘4 ' j \ : 


ie we akin toy, Foy oo Galata od 


4 oa 


A Rat so Cre a, 4 ; am bite? soe an ie reo v ahh pede 
ik Bee Thay LS Tonos: Ss pists Ff on wht OF 
. ,u. } ae ' . i ' My ; 
aoa %, 
vs . 
yor ee, A ae Wait im 
: f ) f , rey 
‘ : Fe 5 
eae ey, “Gs *, a sd: 
bs 43 +" oo 
; a J é y ¢ ¥ ; ws ' 
¥ 4 i wed %, id ie casa #1 rs me ; 
ee bY Ua ca | 4 tx Toe oth Eaves 
BS RS Cs AM Pa Ne a ae 
PART A Mee Paes aa 
iy + f € i r b 


Esteem oat okderiglaty WE yt be: Bilyay yell, 
k or fritar Figg abd Wares testi tee ai or ip bon 
ito wot 1 CU ; wey path yi (0) aslo ¢ ets aa ergy sie 

os sas, apn cad ipsa me Lamead af), eke poe rt ds it 
site cnet aw gu3 wt stasis “a dau tedelnib.& 20,2 att erent 
jet hia, fone val Toad ego’ panting P77 oj Logs wd Ao 
“ Gobi %h destbu a mie.» Tn alvin ’d Ad acelaridoorent: Weve tedidin © ee) 
a ye arrAngenle Hite pa ies dena bt EL ESO), a 
el minh er sth cad barnes sscrilbitnot eos 20) Rom vob 75 RSI o hoes 
¥ om OHS ie Has.diog vihae snotiguylate 5 aie ich 


‘ae abi Vert] liivweamiie, ail aoyeeiion bey 


5 


A LRG, SOGmBR seh Lae ep tinty. THOM! 
re, vi ok, ile eee Py bbl yy old Ay hy io ytd eqigeat! wrt harhe ft. jie 0 
sarki Hav vei’ put. por etelgewad h br wot, Dod edge | vite cif 
ts pesitinn, tthe ALMA ipiineans: Pad Tey jaeenallat ‘hc sient OMe 
SOetippmsicn ini. cat he yeilba. ovf nie es Filia amet” Hate 
frum frhthas eine Reges coe pe “verreihd vite, BH iui i 
f.8 adhe be AE yithy nes wal YS oi 5th a aed ab uae 2 : 
ce ee Ue nd. ee LAD bh ote SA SADT. 
ae aber: Hf. motes a AE main Tie Aadepetiba oly 25 Bi 
) Bas ductors om. re § bit 8) dr a ease fe ctl Hits}: u 
na: A de RO ato Ry Ly a 7 | . 
tor bin gehoaspne rt ai yrotie 3 hard 
~ as Sacey oldsdine A 0 haoty ae Haonturnad Ty sidelis ' es 
5 “i 7 


‘po Ipvivit bik fe busbar ear Le mevoe TL odoin obiuitgy as oy ply 3: aie 
_ piliaailapies rroqeuaTt oe Setnirphesnby dive ail ayerbeociody alt 


a ommend: diet GS Gee Shwe a hiya aOkoY ai} ot binotew iw aot 
’ Poo 5 . 4 ind m i, ep " 
. Segtub: ngadd n't at vem catiwh nin Jono Daa nonameioy 1 
Pha . i ; , ~ 4 fr \ , ‘ av ays H : ry 
, He sy < shored. + P( AON ae wih ky i Pa ri A } f Ny ae ye i re : Pk 

<6 . ph { o> es) i * Wop 4 


pod) eva 4 5 tk he soy sails on hy TGs pele siltsy2 old, bine 
tient Be AaGT, 407 gidinrogeed, #1. Dik Bhagat oil lagtign a a 


: 
; 4 aqui loa gins yO et Eat e id, ane a mb ees 
a * at Oa ha" 


ort ire Al | 
r. 1 AN i SPARES Ah) hn, AW... a i. gts 
es JuwdTth aii-we 49M Rag lernion ¥ sent a 
spy ah ao ole i) ay ait Daa ‘sy yeicl Iie 1D, i & “sel tie gre ‘ 


m Hid oo [ike Dis BU ru. no. al aruba: uA, ibelgamon re a 
ae BIL, anilnvl sxinted soil WL, eal ue qTpqord sti rie Ms 

amon, WATE 20 | AQIS perl Ignoaang dite engl ta N. 
‘4 pareeet: =. is iit vt uy, SEO ect Bone Ni om ‘ i 


~~ 


ts 


his) 


He a ct o5 
ae 


[S. R. No. 70, C. No. 1.] 
18 


adviser in all veterinary matters pertaining to the port. He will 
supervise and direct the veterinary service of the port and of all 
animal transports. His relation to the veterinary service of the 
animal embarkation depot and of other camps at the port is 
similiar to that of a division veterinarian to the veterinary serv- 
ice of the auxiliary remount depot and of divisional units in a 
cantonment, respectively. (S. R. No. 70, C. No. 1, July 5, 1918.) 
[062.12, A. G. O.] 

71. Under the orders of the commanding general he will main- 
tain an ofiice at headquarters of the port, and in addition to 
other administrative duties of his office will provide for a trans- 
port veterinary service, a transport inspection service, and a 
meat and dairy inspection service. He will detail all veterinary 
officers and enlisted men to appropriate duties. In order that the 
services of all casual veterinary personnel may be utilized at 
the animal embarkation depot he will, after conferring with 
the commanding officer thereof, recommend suitable temporary 
assignments as required. (S. R. No. 70, C. No. 1, July 5, 1918.) 

[062.12, A. G. O.] 

72. He will see .that all animal transports are provided with 
adequate veterinary personnel. He will assign to available 
transports veterinary officers detailed to the port by War De- 
partment orders for transport duty, and when no such officer 
is available will recommend the detail of a suitable casual or 
other available officer. If several veterinarians are to travel on 
the same boat, he will designate one as transport veterinarian, 
who should be the senior in rank, He will see that all transport 
veterinarians and personnel are fully instructed in their duties. 
(S. R. No. 70, CO. No. 1, July 5, 1918.) 

[062.12, A. G. O.] 

73. He will also supervise the veterinary sanitation of all 
animal transports and is responsible for making timely recom- 
mendations to the commanding general for the correction of 
sanitary defects. He will make or cause to be made a sanitary 
inspection of every animal transport on its arrival in port. He 
will supervise all cleaning and disinfection of the quarters 
occupied by animals on transports, and will see that they are 
put in proper sanitary condition before loading. He will make 
at least one personal inspection of every transport before it 
leaves port, examining carefully into all the arrangements con- 
cerning the health and sanitation of the animals, He will in- 


a 


[S. R. No. 70, C. No. 1.7 
19 


spect the ramps and other facilities for loading; the accom- 
modations for the animals, including the type and suitability 
of the fittings, adequacy of head room, space for each animal, 
and space for cleaning, feeding, or removal of sick or injured; 
the method of tying in stalls; the provisions for insuring and 
distributing an adequate supply of fresh air, both by artificial 
means or auxiliary ventilating apparatus, such as wind sails; 
the arrangements for cleaning and flushing all decks; the light- 
ing, including lanterns or candles in case of failure of the elec- 
tric lighting; the water supply as to quality, adequacy, and 
provision for renewal, and the cleanliness of storage tanks; and 
the forage as to quantity, quality, and storage facilities. He 
should see that thermometers are provided for all holds in 
which animals are carried, and that there is an adequate supply 
of forks, shovels, and rubber hose. He will also inspect the 
equipment and quarters of the veterinary detachment on a 
transport. He will inspect the veterinary supplies, instruments, 
disinfecting apparatus, or other facilities provided for the care 
of sick or injured animals and for the prevention of disease, 
and will take prompt steps to remedy any deficiencies. At least 
one double stall on each animal deck convenient of access to a 
hatchway should be left empty when loading in order that dis- 
abled animals may be cared for, (S. R. No. 70, C. No. 1, July 5, 
1918.) 
[062.12, A. G.O.] 

74. He will also supervise the loading of all animal trans- 
ports. He will require a critical examination to be made of 
each animal to be embarked and is responsible that only healthy 


animals are shipped. (S. R. No. 70, C. No. 1, July 5, 1918.) 
(062.12, A. G. O.] 


‘75. He will designate one of his commissioned assistants as 
meat and dairy inspector for the entire port, who will perform 
the duties and make reports similar to those of a division meat 
inspector. The port veterinarian will indorse to the port surgeon 
with appropriate remarks one copy of the weekly report on 
Form 110, M. D., and one copy of any special reports from the 
meat and dairy inspector. Copies of these reports will also be 
forwarded to the Director of the Veterinary Corps, Office of the 
Surgeon General, through military channels. (S. R. No. 70, 0, 


No. 1, July 5, 1918.) 
[062.12, A. G. O.] 


4) fer. >) eRe 

V i ie 
ataile é és 
a 


wed} Yaron toy ter wl hier 8 

PaO HET bye y piel Set yseirbened late 
en Hoes TOP a ep Vr PID PAL: Th eal pepm 
RalI3d SRAM eit es eee ia ah seo 
Hada NOT aadiatvorny offeT) ative! ce ary oe 
44 het 4a? ie tik “su aie. Phares aféopaba yd a 


"4 : % Pog wy ora . 
Tete. aia average’. Sane at Peery Mena Ee 
ate este ‘Pht ecideatt bier go linsige ret aioe 


} - m4 j * os 7 rn a ¢ 
fod erty Ener ey a 4 Petpet Ay war Ie i at Le aroha 
n N Ligt e MS & iif ae onal vie eP He en $43 (fi PalnewT ee 

hil “eden nats to eentitesls sei Pim fag #4, bse “— 


wy’s Faye rive Pai oe (a tke 
f ta aac | rf ty Fi Poe ee ae eases “ol 
re 
» % 
7h) BS oy 
‘ ; 
e Wid VeiThige 
a 
{ - 
TF SPP 
f 2 P PS 7 ‘ oe et Lewed ’ 7 
{Tt ened Pee ms y ees eAth Wg ' , ai , 

, ae \ ay F oN Wee) or ieee re YY 4 “i 

ae “4 } ‘ vk } , 

a | "3 4 

f 
§ y G. "< 
> ‘ k LaF 
+" ‘ 7 7 
; I i<y}} { “FT Os Mie 


AN, 43 eh os Me - Pat ees We eee uty tt Ghat ie 


oy oe h, ‘ F , mY ne . : f 
a ER SE ° RRA GRRE TES Ee Pe TMA FSD ‘spa pel LO 


Ree eee GG ¥, «| j * ar aid ‘Lan Me AG 
+ ee + ta 408 ar ‘ a 6 . - 
. p ’ 
| 
f / 
: 
: 
¢ Tks ¥ oe a3 
f < re x : 407] VOW eee 
APT AY Pane Ged tae bo yy TG : ‘ey 
\ vs * \ z my : p 
rai Heo eh apie tes. EP | 
= eet td 2 Tc ae oe 
atic alee J Paty 
“4 
* 
kK Uy, ot 1 ig +X 
ane + my “ f= 8 . y ell Fae wey « 
. Tan 
; i 
A bid vi 
net ee ey Perey Cy (Fl oak , fi ae 


¥ 
§ 

4 , ee 4 P 

ae | ryuaeiel t Ve VAT Tie Pte eee 


} ey i fay 
; £ 
{ » 7 i 
; SVE a PLE ACL, £02 Seats : rate gil Poesy 
{i oe wot icy | ey Oty ey: FY ‘vite ms ay tev 
} iy * 
+ . 4 


WET (er? RPT IT LAM H Lan re eS: ‘yaar 


NRT Lee Rey Gon PE 6 “Shige Naw tergaa ‘hint 


- 


Wat Py BOTH BOOP aan ha alt Ty tote rh T act « iss wy 
‘ t wh 1 
oat ie qcilivifine Wairotdt tos 


CL. " . 
bet Feemeih ss. Ga ‘ 
“ny tt EL bh 


“we 


e 


[S. R. No. 70, C. No. 1.] 
| 20 


76. He will prepare requisitions in quadruplicate on Form 35, 
M. D., for veterinary supplies for the port and transport service, 
referring three copies to the port surgeon for approval, after 
which two copies are sent to the officer in charge of the medical 
supply depot of the port for issue and one forwarded to the 
Surgeon General. (S. R. No. 70, C. No. 1, July 5, 1918.) 

[062.12, A. G. 0O.] 


77. He will report on each animal shipment to the Director of 
the Veterinary Corps, Office of the Surgeon General. This report 
when completed will consist of three parts: (a@) Report of sani- 
tary inspection of the transport before it sailed; (b) completed 
report on Form 113, M. D., which is the transport veterinarian’s 
report; (c) report of inspection of the transport on its return 
to home port. Since the transport veterinarian’s report can not 
be completed until the end of the trip, the report called for in 
this paragraph will not ordinarily be forwarded until Form 113 
has been received and the transport has returned. It will be 
prepared in duplicate and ona copy forwarded through military 
channels to the Director of the Veterinary Corps, Office of the 
Surgeon General. (S. R. No. 70, C. No. 1, July 5, 1918.) 

[062.12, A. G. O.] . 


78. He will also prepare monthly reports on Forms 111, M. D., 

' and 47A, M. D., covering all veterinary personnel permanently 

assigned to the port in duplicate, retaining one copy and for- 

warding one direct to the Director of the Veterinary Corps, Office 

of the Surgeon General. (S. R. No. 70, C. No. 1, July 5, 1918.) 
[062.12, A. G. O.] 


VETERINARY TRANPORT SERVICE. 


79. The transport veterinarian or veterinary officer acting as 
such will have charge of all veterinary personnel on board and 
will assign officers and men to appropriate duties. He will 
utilize the services of casuals as he deems advisable. <A veteri- 
nary officer commanding a unit or detachment proceeding over 
seas will, when called on by the transport veterinarian, place 
the services of all or of any part of his organization at the dis- 
posal of the transport veterinarian. When necessary the latter 
will call on the officer in charge for the assignment of additional 
men. Under direction of the port veterinarian he will be con- 
stantly present during the loading of his transport. He will 


> 


[S. R. No. 70, C. No. 1.] 
21 


promptly report to the port veterinarian any animals physically 

unfit or any defects in sanitary conditions which should be 

corrected before loading. (S. R. No. 70, C. No. 1, July 5, 1918.) 
1062.12, A. 'G: O.] 

80. The transport veterinarian will have charge of the sanita- 
tion of that part of the ship occupied by animals. He will be 
the veterinary adviser of the officer in charge, and will exercise 
supervision over the feeding, watering, stabling, grooming, and 
exercising of the animals; the ventilation, lighting, and cleaning 
of their quarters; and the handling and storage of forage. He 
will see that all available methods of artificial ventilation are 
utilized. (S. R. No. 70, C. No. 1, July 5, 1918.) 

[Q62.129 A. G.- OF] 

81. He will be responsible for the proper care of all sick or 
injured animals, and will request their removal to such places 
as he may consider advisable. (S. R. No. 70, C. No. 1, July 5, 
1918.) 

See DORR MG RAW FZ. 

83. He will be responsible for the proper economical use of all 
veterinary supplies and equipment. On arrival at the home port 
he will take prompt steps to renew supplies and repair or replace 
equipment to the end that both may be adequate and serviceable 
at all times. (S. R. No. 70, C. No. 1, July 5, 1918.) 

FiGeto. A. Go, O:) 

84. He will make a daily sanitary inspection of all animals 
and their surroundings, and will make prompt recommendations 
to the officer in charge for the correction of any defects. He will 
keep a record of his inspections and of the recommendations 
made to the officer in charge, with the action taken thereon. 
(S. R. No. 70, C. No. 1, July 5, 1918.) 

[062.12, A. G. O.] 

85. When transports return empty every effort will be made 
to clean, disinfect, and put the quarters to be used by animals in 
the best possible condition while en route, so that loading may 
not be delayed after arrival. This work will be supervised by 
the transport veterinarian, and the officer in charge will furnish 
the necessary assistance. (S. R. No. 70, C. No. 1, July 5, 1918.) 

[062.12, A. G. O.] 

86. Upon returning to the home port he will prepare a report, 
consisting of Form 113, M. D., completed and accompanied by the 
record of the daily inspections and the recommendations made 


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Pe ae eee padi me a a 


[S. R. No. 70, C. No. 1.] 
22 


to the officer in charge with action thereon, together with any 
further information or recommendations he deems advisable. 
The entire report will be made in triplicate, one copy retained 
and two furnished the port veterinarian, Should he be an act- 
ing transport veterinarian for the trip only and not return 
with the transport, he will promptly forward his report by 
mail to the port veterinarian. (S. R. No. 70, C. No. 1, July 5, 
1918.) 
[062.12, A. G. O.] 


ANIMAL EMBARKATION DEPOTS. 


87. The senior veterinary officer assigned to an embarkation 
depot will be designated as the veterinarian, Under the com- 
manding officer of the depot his duties are the same as those of 
the veterinarian at an auxiliary remount depot. He will make 
the same reports and returns, except that one report only will 
be required weekly on Form 102, M. D. As a-detachment com- 
mander he is equally responsible for the care, discipline, instruc- 
tion, equipment, and assignment to duty of all veterinary per- 
sonnel at the depot. He will prepare requisitions for veterinary 
supplies in quadruplicate on Form 35, M. D., and forward three 
copies to the port surgeon for approval, after which two copies 
are sent to the officer in charge of the medical supply depot at 
the port for issue and one forwarded to the Surgeon General. 
(S. R. No. 70, C. No. 1, July 5, 1918.) 

[062.12, A. G. O.] 


NOTIFICATION OF COMMUNICABLE DISEASE, 


874. The veterinarian of any command will promptly notify 
the State veterinarian, if there is one, of all cases of glanders 
or other communicable disease occurring in the command of 
which such authority would take cognizance were the same to 
occur in the community subject to its supervision. (S. R. No. 70, 
C. No. 1, July 5, 1918.) 

(062.12, A. G. O.] 


VETERINARY SANITARY INSPECTIONS AND REPORTS, 


874. The veterinarian of every mobile unit, camp, depot, post, 
or command, under the direction of the commanding officer, will 


” 


[S. R. No. 70, C. No. 1.] 


23 


supervise the hygiene of public animals and recommend such 
measures as he may deem necessary to prevent or diminish 
disease amongst them. He will examine at least once a month 
the sanitary condition and suitability of stables, corrals, picket 
lines, and veterinary hospital buildings and their surroundings ; 
the method of disposal of manure; the bedding; the kind, 
quality, adequacy, and condition of forage and storage of the 
same; the water supply and condition of watering places and 
containers ; the methods of feeding and watering; the grooming, 
including clipping and trimming, the exercise, the shoeing, the 
fit of saddles, harness, etc., and condition of same, in so far as 
these matters affect the health and condition of the animals; the 
disposition of dead animals; the character and cause of pre- 
vailing animal diseases and measures taken to prevent them. 
Immediately after such examination he will report thereon in 
writing to the commanding officer, noting also in the report the 
dates on which other veterinary sanitary inspections of the 
various organizations of the command were made during the 
month, with such recommendations as he may deem proper. 
The commanding officer will file the report, noting therein his 
views and the action taken by him; and should he have deemed 
the action recommended by the veterinarian impracticable or 
undesirable he will state fully his objections. The commanding 
officer will furnish the veterinarian with a copy of his notation 
in the report. Inspectors general will consult these reports in 
making inspections. The monthly veterinary sanitary report 
will be submitted on Form 103, M. D. Any veterinarian having 
knowledge of insanitary or other conditions which may affect 
or tend to affect the health of the command will furnish the 
surgeon with prompt and full information regarding the same. 
(S, R. No. 70, C. No. 1, July 5, 1918.) 
[062.12, A. G. O.] 


155. Rescinded. (S. R. No. 70, C. No. 1, July 5, 1918.) 
[062.12, A. G. O.] 


SECTION V. 


NOMENCLATURE OF DISEASES AND RULES FOR RECORDING DISABILITIES 
OF ANIMALS. 


156. Diseases and injuries will, so far as practicable, be 
recorded in reports in accordance with the following table of 
diagnostic terms. The table will serve as a guide in this regard, 


“ 


re we a Poth Bh ney 6 aims Ss. 
| forte. badidmovet ire, olen ten i astige ah pene. 
deithaltrors agaroi of saRgaiet sob, Ag aa 
Mince deena try center miege Mbvy, ohh, mot 
hes sitpy lea Hedy contd ete: ho vilidoiine has why (vse 
raynibayoniua toro 2 uring: fpiicgege, scan jor 
‘te id :odt 7 Raibhod abd <2 UBER IO I egpaneg@ Lhd 10, 
MEH Ti ee bag: 685 AE yd farky ory Deity, pea 
hiro eiaeky wriaetaw ‘lo ottbites parts “elngare ot 
Bah eure Cog ha Pa tse hw bere a grit? ty ativan Mae wilt 34 + 
att acrigole oft aclowere otlt vainnalid Dee solqaite Dy | 
Ag vei oe ft Aree Tater iif sasce hint sv Teer eel watt a 3 
ot Py iaatis ad¢ to otha bee ised oly. soothe bolt st ano f. 
AG he those irc yhictaie ate te asa ivea? hie" ¢ hentia 
} ead wiwar pt y to (tae Pf geeycrenteyci Tie aon eR 
HY koerads Peg: i Aiea nha a tlk (aon s 
HY Peaepye ENGR oi’ ib “ATHO Oe SHORE 2 riviAnnete A 
Alte Ay natin Sales ey 1AAE eae at 
Ach hc et ait 4 ie Pitot veep AIO ANC TS 
eae ice epL) sas yt ey) Bets BE ees ‘Gian 
ate: gravad! Bde authiod Sr SOP) thee son he ly eth . 
volte tals! Sa neato baci | 

Hist atta) ania potee Tagh ges: ' > jpo Bitte dino 
Th iiMercite-s Be “elenitvotdey & Eth iy oh aaa DE tere | 
Ha What io RG fae he aibtines sjgetals datawe 
dT Abbey aaset itive Th Cebaadis: “eb tare at BS ae 
edeinn ¥rathetee: ie “eal aft. BEODSS 
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miyis Ga eli fil abiay {ae & ee Hive midis with | 


1 


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[S. R. No. 70, C. No. 1.] 
24 


but it is not intended that it shall be followed literally. When 
diseases or injuries occur for which no terms are furnished by 
the table, or for which the terms furnished are general in char- 
acter, they will be recorded under such scientific terms com- 
monly applied to them by the veterinary profession as will 
briefly and accurately describe them. 

(a) The letter L in parenthesis following a term indicates 
that the location of the disability must be recorded; the letter C, 
its cause; and the letter V, its variety. 


DIAGNOSTIC TERMS, 


Abortion. Calcification of cartilage (L.). 4 
Abscess (L. C.). Caleulus (L.). 
Acne, Canker. 
Actinomycosis. Carcinoma (L.). 
. Adenoma (L.). Cardiac disorder, functional. 
African horse sickness. Cardiac hypertrophy. 
Alopecia. Cardiac hypertrophy and dila- 
Amaurosis (C.). tation. 
Amblyopia. Cardiac murmurs, not organic. 
Anemia, infectious (‘Swamp | Cardiac murmurs, organic. 
fever ’’). Cardiac palpitation 
Anemia. (“ thumps ”’). 
Angioma (L.). i Caries dentium. 
Ankyloblepharon. Cataract. 
Ankylosis (lL. C.). Cellulitis (L. C. V.). 
Anthrax. Cestode infection (tapeworm). 
Aphagia. Chalazion. 
Apoplexy (hemorrhage  into| Cholelithiasis. 
brain). Chondroma (L.). 
Arthritis (L. C. V.). Chorea. 
Ascaris megalocephala. Choroidal tumor, 
Ascites (C.) Choroiditis. 
Aspergillosis. Cicatrices of (L. C.). 
’ Atrophy of (L. C.). Cicatricial deformity (lL. C.). 
Autointoxication. Cleft palate. 
Axoturia. Coital exanthema. @ 
Balanitis. Colic, embolic. 
Bladder, urinary, eversion of. | Colic, spasmodic. 
Bladder, rupture of. Colic, worm. 
Blepharitis. Condyloma acuminatum (warts, 
Blepharospasm, external genital organs). 
Borna’s disease (infectious | Conical cornea. 
meningo-encephalitis). Conjunctivitis, catarrhal. 
Bronchiectasis. Conjunetivitis, chemical. 
Bronchitis (V.). Conjunctivitis, granular. 
Broncho-pneumonia. Conjunctivitis, purulent. 


Bursitis (L. C. V.). Conjunctivitis, traumatic. 


© 


[S. R. No. 70, C. No. 1.] 


25 


Constipation, cause not deter- 
mined or when _ secondary 
diagnosis. 

Contracture of (muscle, fascia, 
tendon, or sheath) (L. C.) 

Corns (poderdermatitis 
ecumscripta). 

Cornua (cutaneous horns). 

Cowperitis. 

Crural paralysis. 

Curb. 

Cryptorchidism. 

Cystitis. 

Cyst (L.). 

Cystic kidney. 

Cysticercus (L.). 

Dacryoadenitis. 

Dacryocystitis. 

Decubitus. 

Dental disease (abnormalities 
of the teeth). 

Dermatitis (L. C. V.). 

Dermatitis, contagiosa pustu- 
losa. ; 

Dermatitis, medicamentosa 
(drug eruptions). 

Dermatitis, verrucosa (‘ gen- 
eral heel ”’). 

Dermoid cyst (L.). 

Detachment of choroid. 

Detachment of retina. 

Deviation of nasal septum. 

Diabetes insipidus. 

Diabetes mellitus. 

Diaphragm, 
(‘thumps ”’). 

Diarrhea, cause not determined 
or when secondary diagnosis. 

Echinococcus. 

Ectropion. 

Eezema seborrhoeicum. 

Edema (L. C.). 

Flephantiasis. 

Embolism (L.). 

Emphysema (L.). 

Enchondroma. 


cir- 


spasm 


Endocarditis, acute (give pri- 


mary disease). 
Endocarditis, chronic. 
Endothelioma (L.). 
Enteritis (C. V.). 


of 


Enteritis membranica 
cous colitis). 

Entropion. 3 

Epididymitis (C. V.). 

Kpididymo-orchitis (C. V.). 

Kpilepsy. 

Hpistaxis. 

Hpithelioma (L.). 

Krysipelas (1L.). 

Ksophagus, diverticula. 

Ksophagus, spasm of. 

Exostoses (L.). 

Extravasation of urine, 

Facial paralysis. 

Favus. 

Fibroma (L.). 

Yilariasis. 

Fistula, dental. 

Vistula, fecal. 

Vistula, ear. 

Fistula, poll. 

Fistula, withers. 

Foot-and-mouth disease. 

Forage poisoning (‘ cerebro- 
spinal meningitis ”’). 

Foreign body in (L. V.). 

Gangrene (L.). 

Gastritis (C. V.). 

Gastro-enteritis (C. V.). 

Gingivitis. 

Glanders. 

Glossitis. 

Goiter. 

Gonitis. 

* Grease heel.” 

Gutteral pouch catarrh. 

Gutteral pouch tympany. 

Hematoma (L.). 

Hematuria. 

Hemiplegia (C.). 

Hemoglobinuria. 

Hemopericardium. 

Hemophilia. 

Hemorrhage (I..). 

Hemorrhagic septicemia. 

Hemorrhoids (V.). 

Hemothorax. 

Hermaphroditism. 

Hernia (L. V.). 

Hernia of muscle (L. V.). 

Hernia strangulated (L.). 


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iF ROES. Rey theuge gatiqdy, an 
ae bee cay joie thrall y,. 
re ery nero ba SLOT | 
e OAL) salah ars 
RMU Silo ub Crates abr gaetqgoett ; 4 
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iy BM ; ART gents ; 
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Es ie ye Aol) pot geng A) ete pe My" ap 
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a ay ninitiide! yorayEE SOR! Pe i 
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moo payne, event ; fle “qo rt 
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claarnoMn iol AS¢o 40 molioatal 
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dochiecaties WR oad lauitesiol 
ets uci moon qi (aoipeial 
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aetiiingnei? domeoalyg . 
soteclov. aco baal bar > Roker: 

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Sevtoktal) sipages tentiastns 
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mo OS a ie + Yo wobaxul jal 
: vin (milaiodtequa ehh) wiedy aM 
feeineTBsronleaon AAG aR EY 
vit nord Rete hy ee 
Sho ets toneta ae ror beler ¢ eh rie FE oe 
Of wis evitaieoly SIO 
a) Sika’ Cor, CHUL bereaet “nee ante 
GO} Guay un scolloanede jose domt |. 
‘ce “tpt reed dgoged 
het, REP ENE AAT est tiste kina 
, My alahirrms noe yi ra Oe 
Rinp- mpthb FORE pee eh Dit. 
earcangelabes, tale Mop al tignnetil 
$6 prise 2 aongunent yedthga tid 
| niin ean sorage AMET BT 
alum aiwyx0 | epteaues te petehe Kagel a 
asin'rtond | weraviry! aired. abiteainegrodae.d: 8" 
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: telot it eaibod mag oy 


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sasheeau Fee Ay rng ae ome . we joann 


[S. R. No. 70, C. No. 1.] 


26 

¢ 
Herpes tonsurans, Mange’ (V.). 
Hordeolum. Mange, pseudo from forage 
Hydrocele. acarini. 
Hydrocephalus, acquired. Mange, suspected. 
Hydronephrosis. Malignant edema, 
Hyperidrosis. ; Malingering. 
Hypertrophy (L). Malnutrition. 
Hypopyon. Melanoma, 
Ichthyosis. Melanosarcoma. 
Impotence. Meningo-encephalitis. 
Incontinence of urine. Meningitis spinalis. 
Vrterct cheesy 0° a! Meteorism (C.). 
Infection of operation wound. | Metritis. 
Influenza. Monorchism. 
Intestinal catarrh. Muscular rheumatism (L. V.). mn 
Intestinal impaction. Myelitis (L. C. V.). ; 


Intestinal impaction with dis- | Myocarditis (V.). 
placement (angulations,}| Myoma (L.). 
kinks, adhesions, volvulus, | Myopia. 


intussusception). Myositis (L. V.). - 
Intestinal rupture (L.). Myxedema. F 
Intestinal toxemia (fermenta-| Nail in the foot (report as 
tion). “picked up nail”) (L.). 
Iridocyclitis. Nasal polypus. 
Tritis. Navicular disease (podotroch- 
Jaundice (C.). learis). 
Joint, luxation of (L.). Necrosis (L.C.). 
Keratitis superficialis. Nephritis (C. V.). 
Keratitis, nonulcerative. Neuritis (optic). 
Keratitis, parenchymatous. Nystagmus. 
Keratitis, phlyctenular. Obesity. 
Keratitis, ulcerative. Omphalitis. 
Keratoderma. Onanism, 
Lachrymal obstruction, Opacity of vitreous. 
Lagophthalmos, | Ophthalmia, periodic. 
Laminitis. Optic atrophy. 
Laryngeal paralysis (‘“‘ roar- | Orchitis. 
ing’’). Osteoma (L.). 
Laryngitis (V.). Osteoporosis. ‘ 
Laryngitis, croupous. Ostitis (L.). @ 
Laryngitis, phlegmonous, acute. | Otitis. 
Larynx, edema of. Oxyuris curvula. 
Leptomeningitis. Pachymeningitis (L. C.). 
Leucoma. Panophthalmitis. 
Lipoma (L.). © Papilloma (L.). 
Loose bodies in joint (L. V.). Paralysis of muscle (L.). 
Lymphangitis (Il. C. V.). Paraphimosis. 
Lymphangitis, epizootic. Paraplegia (C.). 
Lymphangitis, ulcerous. Parotitis. 


Lymphosarcoma (L.). Pediculosis. 


1 Must always be confirmed by microscopic examination. 


© 


[S. R. No. 70, C. No. 1.] 


27 


Pemphigus. 

Penetrating street nail (report 
as “picked up nail”) (L.). 
Perforated nasal septum. 

Pericariditis (V.). 

Perichronditis (C.). 

Periorchitis. 

Periostitis (L.). 

Peritoneal adhesions. 

Peritonitis (V.). 

Pharyngitis. 

Pharynx, phlegmonous 
tion, acute, 

Phimosis. 

Phlebitis (..C. V.). 

Phlegmona diffusa. 

Phthiriasis (pediculosis; lice), 

Picked-up nail. 

Piroplasmosis (biliary fever). 

Pleurisy, fibrinous. 

Pleurisy, serofibrinous. 

Pleurisy, suppurative. 


infec- 


Pleuritic adhesions. 
Pneumonia, foreign body 
(traumatic pneumonia). 
Pneumonia, infectious _ fibri- 
nous (contagious pneumo- 

nia). 


Pneumonia, interstital. 

Pneumonia, lobar. 

Pneumonia, unclassified. 

Pneumopericardium. 

Pneumothorax. 

Pododermatitis (C. V.). 

Poisoning (C.). 

Polypus, nasal. 

Priapism. 

Proctitis. 

Pros‘atis. 

Pruritus. 

Pterygium. 

Ptosis. 

Pulmonary congestion. 

Pulmonary edema. 

Purpura hemorrhagica (pete- 
chial fever). 

Pyaemia (C.)., 

Pyelitis. 

Pyelonephritis. 

Pyopneumothorax, 

Quittor. 

Rabies. 


Radial paralysis. 

Rectum, prolapse of, 

Retention cyst (L.). 

Retention of urine. 

Retinitis (V.). 

Retrobulbarneuritis. 

Rhinitis, acute. 

Rhinitis, croupous. 

Rickets. 

Ringbone. 

“ Roaring” (laryngeal paraly- 
sis). 

Sandcracks. 

Sapremia. 

Sarcoma (L.). 

Satyriasis. — 

Scabies. 

Scirrhous cord. 

Screw worm (compsomina ma- 
cellaria larvae). 

Seasickness. 

Seedy toe. 

Septicemia. 

Shock. 


-Sidebone. 


Sinus, empyema (L.). 
Splints. 
Spavin (V.). 
Sprains (L.). 
Sporotrichosis. 
Staphyloma of cornea. 
Stenosis (L. C.). 
Stomach, acute dilatation of. 
Stomach, dilatation of. 
Stomach, rupture of. 
Stomatitis, aphthous. 
Stomatitis, catarrhal. 
Stomatitis, contagious. 
Stomatitis, mercurial. 
Stomatitis, ulcerative. 
Strangles. 
Stricture (L. C.). 
Strongyloides, intestinal. 
Subscapular paralysis 
(‘‘ Shoulder slip ’’). 
Symblepharon. 
Synechia. 
Synovitis of (L. C. V.). 
Tendinitis. 
Tendovaginitis. 
Tetanus. 
Thoroughpin. 


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4 | joeme: I | Sowers, algal 


Say ba bamow todai; ily onnvel B. fra dif Fu ae 
: fang at marcy tetet | M OMS NR aan Miscac ap 
*. rae: may agastetenus! | | i. al AIO ga0o0.4 KA! 
dear” 243) srpsqnt Jia) | ‘3 Be ict etl eons | 
] pam Phi (haw), Bei 1%. 


ame Scie Fine iat 


eee Bee 


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seep’ “Aiitvitonat fed 
< 


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potyatne wacky AM, isin aie A 
ais ornate 


9 = Sow. om (aly oldman ed cee if 
TO a Mi al alae abe i Me i 


[S. R. No. 70, C. No. 1.] 


28 
Thrombosis (1.) Kpiphyseal separation (state 
Thrush. bone). 
Ticks. Exhaustion from overexertion. 
Trichorrhexis nodosa. Iixhaustion from overexposure. 
Trypanosomiasis. Exposure to extreme cold. 
Tuberculosis (L.). Kye, traumatic rupture of. 
Tumor, benign (L. V.). Kye, other wounds and injuries 
Tumor, brain. of (C.). 
Tumor, malignant (L. V.). Foreign body, traumatic (L.). 
Tumor, spinal cord. Fracture, compound (L, C.).<= 
Ulcer (L. C. V.) Fracture, simple (L. C.). 
Under observation (undiag- | Fracture, comminuted (lL. C.). 
nosed or unknown). Fracture of >. faulty 
Union of fracture faulty. union following. 
Uremia. Gall, crupper. 
Urethra, stricture of. Gall, girth. 
Urticaria. Gall, halter. 
Uterus, rupture of. : Gall, harness, 
Vaccinia (cowpox). Gall, saddle, 
Vagina, rupture of. Gassed. 
Valvular,:- heart disease (V.). |Gunshot wound (1.). 
Varicocele. Hematona, traumatic (L.). 
Varicose veins (L.). Hemorrhage (L. C.). 
Variola, equine. Heart rupture (C.), 
Verruca (wart). Heat stroke, 
Vertigo. Infection of wound. 
ye arrsee i ' Interfering. 
| Traumatisms. Lightning stroke. 

S hae Myelitis, traumatic. 

u Abrasion (L. C.). Overreach. 

Bite. Poisoning by food (specify 
Blister (L. C.). food). i. 


Poisoning, other, acute. 
Prolapse of iris. 

Rupture of organ (L, C.), 
Scratches. 


Burn (L, C. V.). 

Burn, chemical (L, C. V.). 
Burn, collar chain. 

Burn, rope. 


Burn, X-ray. Smoke inhalation. 
aa Castration. Sprain of joint (L.). 
* Cataract, traumatic. Speedy cut. 
f) Compression. Starvation. 
‘ Concussion (L. C.). Strain (state muscle), 2 
Conjunctivitis, traumatic. Strangulation. 
\\NGa? «=Cornea, foreign body in. Suffocation, 
A Crushing (L, C.). Sunstroke. 


Synovitis, traumatie (L. C.). 
Traumatic neuritis. 

Treads, calk. 

Urinary calculus. 

Hlectrical shock. Venomous bite or sting. 
Electrical burn. Wound, contused (L, C.). 
Emphysema, traumatic (L.). | Wound, extensive. 


Deprivation of water. 
\ Dermatitis traumatica. 
‘\\ Dislocation (L. C. V.). 

~ Drowning. 


Se 
ee ee ee 


[S. R. No. 70, C. No. 1.] 


Ae 
Wound, incised (L. C.). Wound, penetrating (L. C.) 
Wound, lacerated (L. C.). (except picked up nail). 
Wound, multiple. Wound, perforating (lL. C.). 


(S. R. No. 70, C. No. 1, July 5, 1918.) 
[062.12, A. G. O.] ; 


BY ORDER OF THE SECRETARY OF WAR: 
PEYTON C. MARCH, 
General, Chief of Staff. 
OFFICIAL: P 
H. P. McCAIN, 
The Adjutant General. 


WASHINGTON : GOVERNMENT PRINTING OFFICE : 1918 


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FRACTURES 191 


For au understanding of the processes of healing, as well as various 
pathological processes in the bone, it is necessary to have a knowledge 
of the physiological development as it occurs in the normal growth 
of bone. Asaresult of the embryological and histological investiga- 
tions of KOlliker, Gegenbauer, Waldeyer, and others, it has 
been demonstrated that bone may develop from periosteum, 
bone-marrow, or cartilage. One distinguishes, then, a peri- 
osteal, a myelogenic or endosteal, and an enchondral formation 
of bone. The organs mentioned supply, first of all, a soft germ-tissue, 
the marrow-tissue (osteoid tissue) in which the OSTEOBLASTS, that is, 
the specific bone-forming cells, then develop. The most important pro- 
cesses are as follows: 

I. Periosteal bone formation is similar to the perichondral 
form which occurs in the fetus, that is, it develops from the inner osteo- 
blastic cell-layer of the periosteum (so-called cambium or formative 
layer) ; the outer layer of the periosteum has few vessels or cells, it is 
rich in connective-tissue fibers, and plays no part in the development of 
bone. The formative layer of the periosteum contains marrow-spaces 
which have a rich cellular and vascular supply. A part of the former 
are transformed into osteoblasts; calcium salts are deposited around 
them and there is formed lamellar-like bone-tissue in which these cel- 
lular elements are confined in sac-like cavities and are retained as so- 
called bone cells. 

2. Myelogenic or endosteal bone formation follows ina 
similar manner, the boundary between the marrow and the tela ossea is 
first supplied with osteoid tissue from the bone-marrow, this is followed 
by the formation of osteoblasts and bone-tissue. 

3. Enchondral bone formation is observed on the epiphyseal 
cartilage of fetal bones; it develops from the osteoblasts and marrow- 
cells of the marrow-cavities in the cartilage. If the epiphyseal symphisis 
is continually irritated (chronic inflammation, compound fractures, 
blows from sticks) developing bone becomes abnormally long (Berg- 
man, Tillman, and others). 

In contrast tothe bone-forming activity of the osteoblasts, there 
stands the resorbing activity of the OSTEOCLASTS; this is constantly 
present in normal bone. The origin of these bone-solving, multinu- 
clear, giant-cells has not yet been demonstrated by any method free 
from objection (descendants of the osteoblasts? the white blood-cor- 
puscles? the endothelial cells of the vessels? the adventitia or perithelial 
cells?). According to Tillman the activity of the osteoclasts is as 
follows: apparently they cause asolution of the calcium salts of the 
bone by the formation of free carbonic acid, thus resorbing the osseous 
matrix, in this manner small cavities or lacunae are formed in the bone 
(lacunar bone resorption, Howship’s lacunae), 


192 FRACTURES 


NATURE AND CAuUSES.—Broken bone or fracture 
is a division of the continuity of the bone; tn contrast to a 
bone-wound the external skin usually remains intact. 

The causes of fracture are either external or internal. 
Most fractures are due to external causes (kicks, blows, 
falls, contusions). One also differentiates between direct and 
indirect bone fractures. A direct fracture occurs at the seat of 
the trauma. An indirect fracture occurs at a distance from 
the seat of the traumatic injury. Contusion- and com- 
pression-fractures belong to the indirect form (fracture of 
the vertebrze from falling on the hind parts); this is also true 
of fractures due to torsion and bending (straining of 
the first phalanx when caught in the rails, fracture of the 
vertebree when cast), andtraction-orstrain-fracture 
(fracture of the calcaneum due to pulling of the achilles tendon 
when falling upon the strongly flexed hind limb). Frac- 
ture by contrecoup orcontra-fracture is classified among 
the indirect forms, it occurs according to the principle of 
contra-fissure (fracture of the sphenoid bone by falling on the 
mouth, fracture of the internal angle of the ilium by falling on 
the tuberosity of the ischium). , 

Fractures may occur in the absence of allexternal trau- 
mata, merely through internal causes, especially as a 
result of increased muscular contractiloms.eee 
called spontaneous bone-fracture is most frequently observed 
when casting horses ; it is due not merely to falling, but oceurs 
as a result of pronounced muscular contraction while the 
animal is lying or balancing ; contraction of the longissimus 
dorsi results in a dorsal or lumbar fracture; severe exertion of 
the retained hind limb, fracture of the femur, tibia, or meta- 
tarsus; severe struggling against retention of the anterior 
limbs may result ina fracture of the scapula or humerus. 
Spontaneous bone-fractures occur even in horses that are 
standing ; the lumbar vertebrzee may be fractured by suddenly 
stopping or turning a horse (Trasbot), violent kicking with 
both hind feet (Haubner), while galloping (Wittman), 
when rising (M oussu); the humerus when traveling rapidly, 
sudden turning of the horse by the rider, and heavy pulls 


ABNORMAL FRAGILITY 193 


(Flook, Penberthy, Ernes, Lagrifoul); the pelvis 
and tarsus by supporting the body weight on one hind limb 
when slipping (personal observations); other bones of the 
hind limbs asa result of severe contraction of the extensors 
when kicking (J oly); the pisiform bone in heavy draft-horses 
(Moller); the lumbar vertebree, femur, and tibia dur- 
ing extraction of the teeth while the animal is standing 
(Eberlein). ~. 

f In many cases neither external nor internal influences can ; 
be demonstrated as causes of bone-fracture. The so-called 
idiopatic fractures must be explained by an abnormal fra- 
gility of the bones (fragilitas ossium, osteopsathyrosis). 
Idiopathic fractures are not uncommon in horses and cattle. 
The fragility is due either to certain pathological con- 
ditions of the bones, especially osteomalacia, rachitis, 
rarefying ostitis, bone caries, sarcoma (melanosarcoma), and 
tuberculosis; or to certain predisposing influences, old age 
(senile atrophy), standing in the stall for a long time 
when convalescent from some disease (atrophy of inac- 
Sivicy);) extreme youth (juvenile bones, intra- 
uterine fractures); disease of the nervous system, es- 
pecially that form which occasionally follows neurotomy 
(trophoneurotic bone-atrophy); restricted mo- 
bility in the joints (anchylosis of the vertebral 
column in the horse sometimes results in fracture of the 
vertebre). Occasionally no cause for the fracture can be 
found, regardless of a careful examination. These cases one 
must account for by individual variations in the solidity 
and elasticity of the bones of different animals. A heredi- 
tary fragility of the foals of certain mares has also been 
observed, it is characterized by numerous fractures. 


ABNORMAL FRAGILITY.—Without the acceptance of this condition 
many cases in veterinary practice are unexplainable. This is espec- 
ially true of those fractures of the spinal column in horses, which, re- 
gardless of the most careful precautions, frequently 
occur when the animal is being cast: they are more com- 
mon than is generally supposed or published. Experience has shown 
that old horses are especially predisposed to this form of fracture (cast- 
ing for operations on the teeth, extirpation of the lateral cartilage). If 


194 FRACTURES 


these fractures are less frequently observed in many countries and 
clinics than in others, it is, according to my judgment, due not only to 
the various methods of casting but to the differences of race and conditions 
of nourishment. Further, this class includes those cases of multiple 
fracture in one and the same animal. Iua cow affected with osteoma- 
lacia the pelvis was fractured no less than fifteen times (Maris). Ina 
sound horse that suddenly became lame after a few jumps when gallop- 
ing, the sesamoid bones were fractured in all four limbs (Rutherford). 
A stallion fractured both femurs during a castration (Haselbach ), 
One horse fractured all four of the second phalanges at the same time 
(Henon); another fractured three suffraginal bones (ROder); many 
others have fractured two of the first or second phalanges (Wend- 
worth, Moller, personal observations). An abnormal fragility of 
the aie and Epa Oa has also been repeated al observed in horses 
(Degive, Thummler, and others). 

The causes of abnormal fragility of bones in old horses are usually 
considered tobe a senile atrophy of the bones, and in young 
horses a rarefying ostitis. Recent investigations by French veter- 
inarians have resulted in an explanation of this problem. Joly and 
Vivien (Recueil. 1g01) found the typical changes of rarefying ostitis 
in a first phalanx that was fractured while the animal was going at an 
ordinary trot. On macroscopic examination a rapid, artificial solution 
of the lime salts of the fractured bone was easily recognized when com- 
pared with the corresponding bone of the other foot. Microscopic 
examination of the fractured bones revealed numerous and extensive 
dilitations of the Haversion canals (rarefying osititis); the articular 
cartilage was secondarily involved (atrophy, penetration of the cartilage 
with vascular loops). Intwo cases of fracture of the lumbar vertebrez 
jn horses Jacouletand Vivien found rarefying ostitis with vascular 
dilitation (redness), liquefaction of the fatty substance (float in water) 
and porosity. 


CLASSIFICATION.—From a practical standpoint the 
most important division is into simple (subcutaneous) and 
compound (open) fractures. Simple, subcutaneous frac- 
ture is a fracture of the bone without an injury to the skin. 
In contrast to this a compound fracture is accompanied by a 
skin-wound, so that the bone is exposed and entrance of 
infection is possible. | 

Further, a classification into complete and incom- 
plete fractures is important. In the former the bone is 
broken across its entire diameter at the point of fracture, so 
that the ends are not attached to each other. The separation 
is only partial in incomplete fracture, there is only a cleft or 


FRACTURES 195 


fissure, that is, a split in the bone (fissure, longitudinal 
fracture), or an infraction or bending (infraction, im- 
pression, depression, subperiosteal fracture, 
green-stick fracture). Fissures most frequently occur 
on the first phalanx and on the tibia ; infractions, on the ribs; 
impressions, on the bones of the skuil. Fissures are often 
transformed later into compound fractures. 

According to the direction of the broken line one distin- 
guishes transverse fractures (fractura transversa); 
oblique fractures (fractura obliqua); longitudinal 
fractures (fractura longitudinalis); spiral fractures 
with a wound-line that takes the form of a screw ; fractures 
in the form of the mouth-piece of a clarionett (fracture en 
bec de flute); Y-shaped fractures; and T-shaped 
fractures (on the first phalanx). 

According to the position of the broken fragments in 
complete fractures various kinds of dislocation are recognized ; 
mamely, dislocatio ad axin (angular fracture); ad 
latus (lateral or transverse displacement); ad periph- 
eram (rotation); ad longitudinam, either with im pac- 
tion (Shortening), or separation (increase in length). 
Impaction is likewise a form of longitudinal dislocation 
with contraction ; diastasis is an opposite condition. 

Further, in contrast to a simple fracture, in which the 
bone is broken only once, one speaks of a multiple fracture 
(tractuta multiplex), doubie fracture, triple fracture, 
etc. They are observed especially on the first and second 
phalanges and on the epiphyseal ends. When the bone is: 
broken into small fragments it is termed acomminuted or 
splinter- fracture (fractura comminuta); when a splinter- 
fracture is characterized by complete crushing of the bone it is 
termed a conquassion fracture (fractura conquassata). The 
latter occurs, for example, in vertebral fractures when casting 
horses. 

Partial bone fracture, which is not uncommon in vet- 
erinary practice, is of importance. Certain portions of the 
bone are broken, not the entire bone. These occur in the fol- 
lowing places: on the lateral tubercles and tuberosities of the 


196 FISSURES 


humerus; on the trocanters of the femur; the spine of the 
scapula; and the oblique and transverse processes of the ver- 
tebree, especiailly the cervical and lumbar vertebre. 


FISSURES.—These are of great practical importance, because in 
horses their occurrence is especially frequent, diagnosis is very diffi_ 
cult, and many cases are finally transformed into complete fractures. 
In addition to the first phalanx and tibia, fissures are found in the 
vertebre, in the scapula, humerus, radius, metacarpus and metatarsus, 
femur, second phalanx, os pedis, in the ulna, etc. Fissures are fre- 
quent in the vicinity of gun-shot-fractures (penetrating shots): .A 
peculiarity of fissures is that after acertain time, often several days, 
they are transformed into complete fractures, this has been repeatedly 
observed in practice. Usually it is unexpected, and occurs during the 
night, when the animal is rising or lying down, on raising the hoof to 
be shod, etc., this is especially true of the tibia and first phalanx. 
Fractures due to kicks on the inner side of the tibia in the horse may 
be transformed into complete fractures after weeks or months (in two 
cases one went for seventy days, the other for one hundred twenty- 
eight days). Alsoin other bones, fractures occur which are transformed 
aftera time into the complete form. Especially remarkable 
are those cases of fissured vertebrae in the horse 
which occur after casting or falling, complete fracture taking 
place after several hours ora few days, even after weeks. They 
are characterized by sudden paralysis of the hind 
parts. Occasionally these occur in horses that have 
been used for saddle or driving purposes regardless 
of the fissure. According to the records of the veterinary litera- 
ture cases of this kind are not uncommon (Spinola, Dieckerhoff, 
Moller, Straube, Gutzlaff, Flatten, Wurgier personal 
observations). I have, for example, observed that after the casting of a 
thorough-bred stallion complete fracture developed from a fissure after 
four weeks (twenty-nine days). During this time the animal was in 
perfect health and stood on all four limbs., In similar cases fissures in 
the horse have developed into fractures after a long time, even weeks; 
fractures of the metacarpus (Bauer), humerus (Philippi, personal 
observations), and radius (Freer, Gunther, Schmid). For refer- 
ence to old fissures from a forensic standpoint see page 210. 


FREQUENCY AND OCCURRENCE.—Fractures of bone most 
often occur in horses and dogs; they are not infrequent 
in cattle, birds and swine. In cats fractures are 
relatively uncommon ; because of their elasticity they may fall 
a considerable distance (several feet) without being injured. 
In the horse the ordinary causes are falls, running into objects, 


FRACTURES 197 


collisions, kicks from horses, casting; in dogs, kicks, bites, 
being run over, squeezed, falls, and stones. Bone-fractures 
in horses and dogs are most often seen in large cities; 
in the former it is due to slipping and falling on hard smooth 
pavements, especially on asphalt when it is covered with 
smooth wet ice; dogs are run over with street cars, hacks, 
and other vehicles. According to my experience in Berlin 
dogs suffer most often from fractures on Sundays (picnic 
parties), for that reason Monday’s clinic is supplied with an 
abundance of material; the same condition follows any inter- 
ruption in traffic. Fractures in war are usually caused by 
projectiles. 

The statistics of the Prussian Army afford valuable material 
Félative to the frequency of fractures in horses. 
Among 30,000 horses, 400 fractures a year occur during times 
of peace. The total number of fractures, covering a period of 
five years (1891-1895) in the Prussian Army was 2000. The 
following regions are most often affected: pelvis, tibia, 
first phalanx, bones of the head, the radius, 
the metatarsus, and the vertebrae. Fractures 
Smetie tibia,spelvis, and the first phalanx 
eover about fiity- per cent of all fractures in 
the horse. 

With reference to the frequency of fractures in the dog, 
my own published statistics covering a period of nine years 
(1886-1894) and 70,000 diseased dogs, show the following 
tesults ;: about 1700 (1693) suffered from fracture, this-amounts 
to 2.3 per cent of the total number of diseased dogs. In 
Berlin, one in forty of all diseased dogs suf- 
fers from fracture. Luxations, in contrast to fractures, 
are less frequent in dogs, uccurring about one fifth as often (I 
have seen only 344 cases in all, equal to .5 percent). Accord- 
ing to my experience the most frequent fractures in the dog 
are of the femur (17 percent), the radius and ulna (15 
per cent), the tibia and fibula (13 per cent), and the 
humerus (5percent). Inthe dog ninety per cent 
of all fractures involve the bones of the ex- 
tremities. The following bones are least often fractured : 


198 STATISTICS 


sternum, bones of the cranium, the vertebral column, the 
patella, the ribs, and the scapula. 

In cattle, fractures most often involve the head of the 
femur, pelvis, scapula, tibia, metatarsus, ang 
bones of the tail. Recorded statistics are wanting. 

With reference to the frequency of fractures in 
swine, information is found in the work of Charpentier 
and Lafourcade. Fifteen percent of all slaugh- 
tered swine show fractures of the ribs in vari- 
ous stages of healing. ‘Transportation in narrow 
quarters explains this condition. 

Frequency of fractures in birds is furnished by the statis- 
tics of Larcher who has treated 250 cases. According to 
Cadiot the following bones are most often fractured : 
humerus, tibia and femur; the radius) )aiaeee 
scapula, and ribs are less frequently fractured. I, my- 
self, have treated 137 fractures in birds, 64 were in large birds 
(hens, swans, parrots), and 73 in small (song and ornamental 
birds). Wings and limbs were most often fractured. 


STATISTICS.—1. Bartke has collected the following statistics om 
the horse from the records of the Prussian Army: in a period cover- 
ing ten years from 1886-1895, of 280,000 diseased animals, bone fracture 
occurred in 3473. Of 3000 recorded fractures, 1i800—equal to 60 per 
cent—involved the limbs; 1ooo—equal to 30 per cent—involved the 
body and vertebral column; 200—equal to ro per cent—involved the 
bones of the head. Individual fractures were as follows: 


SPA ine” ee bs ONE) et or eee 557 times 18 per cent. 
Pelvis ee 3 a es ete aed La SUE NAOT Me 16 8 
Hirst cr akan ee SC el AOA lars 13 « 
Reding wee et aes eee oT a 8 a 
Cervical Vertebree.. 7 eae ee 2377 an 8 e 
IML CLA CATDUG © 20 cre ee eres 2105: 7 a 
um bar Verte brass: 2 sey seen hag bape is aS 
Dorsal Vertebree_. 0 oe Ae ek 255 these 
Humerne ety oop ia ee ame. 2 5 ines 
UH pied ieee So ee bom < 2 Res 
Ribs mete ee 5 ee eee Saris 2 J 
Feriatirmese 2 295 181.4) Oy ate ae BO Ge: ae 
Secongsa. nalanx,: oo gigs eames Gchtrs 2 s 
Third Pielanx./5) Aiea B20 2 7 


© 
Q 
Q 

bade 
45) 

pte 
co 

es) 

— 

ee) 

fe) 

B 

a’) 

| 

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| 

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' 

' 

1 

| 

{ 

{ 

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i} 
On 

Nd 

iS) 


STATISTICS 199 


MOUENGtO BONG 22.2.0 i oe 43 times 1.5 per cent. 
(LESAN GU 5 hes Oy 5 a a eR Beane I i. 
PrOrnuerOtie. su ee ON Qarars I bi 
Bugemoc Maxilia® 2 Lk Bares I i 
PremOTenlaxtiad uo Te aries I bu 


In the years 1895-1902 at the Surgical Clinic of the Berlin Veteri- 
nary School I treated 308 fractures from a total of 7000 diseased horses. 
Of these, 103 involved the pelvis, 43 the bones of the head, 38 the first 
phalanx, 21 the vertebre, 14 the scapula, 14 the humerus, 13 the tibia, 
, 12 the second phalanx, 12 the femur, 9 the third phalanx, 6 the navicular 
bone, 5 the ulna, 4 the ribs, 4 the radius, 3 the metatarsus, 2 the sacrum, 
I the tarsus, 1 the carpus, 1 the patella, and 1 the sternum. 

According to Cadiot (clinic in Alfort) 159 fractures of the 
extremities of the horse were distributed as follows: tibia 32, pelvis 30, 
first phalanx 24, radius 17, metacarpus 15, humerus 13, femur and ulna 
6, scapula 5, second phalanx 4, carpus 3, third phalanx 2, calcaneum and 
trochlea r. Morkeberg at the Copenhagen Clinic has treated 69 frac- 
tures in the horse in the years 1896-1900. The fractures were distributed 
as follows: pelvis 31, first, second, and third phalanges 15, bones of the 
head 7, ribs 5 times. According to Verlinde 42 fractures occurred 
in twelve years in three Belgian Cavalry Regiments. They were dis- 
tributed as follows: femur 21, third phalanx 2, navicular, first phalanx, 
and second phalanx I. 

2. Ihave observed 1693 cases of fractures in dogs (548in the 
hospital clinic, 1145 in the polyclinic). 1145 fractures in the polyclinic 
were distributed as follows: head 22, trunk 60, anterior limbs 434, pos- 
terior limbs 537. Individual fractures compiled from 915 cases were 
distributed as follows: 


per cent 
J ULGSNIYE by SOL Se Se DMT ae 188 times 17.0 
Patines ANC UIMae ss oe St st 7h teal ey fal Jak 15.0 
Peotone rs pilav so oS TAs. 13.0 
PUTO Gi eee se 5S se 5.0 
PGA EARStS et We ral eae 4.0 
MI@EICAT DUS oes Ss kk AO seas 3.5 
CPS IG Ty SS kaa oe BO es 3.0 
Anterior Phalanges____________ SQihic. 3.0 
Posterior Phalanges________.__. Ewart 3.0 
[PPL TO sot an EAS a BO We 2.5 
TORRESEN 2” pl LI a a pik ees: 2.5 
Rocev veri Vertepra. 2) 20 tak 2.5 
cap aemeete are ore 8a Lanse 1.5 
VERS Teo See Re Ope eee TOVeECs 1.5 
terior: Vaxilla. co ek. TOM Ts 
Pamuare vertebra: 1B ieee ie) 
DrearealeVertebrees ee Siping 0.5 
Sere ey eet eee ore Hd 0.2 


200 SYMPTOMS AND DIAGNOSIS 


With reference to the resistance (resistance to pressure) of bones in 
different races and species, information has been supplied by the recent 
investigations of Hoffman (Berl. tieraertl, Wochenschr. Igo1). Of 
the long bones of the extremities in the horse, the metatarsus was the 
most resistant. A difference in breed was not observed ; age, on the 
other hand, resulted in variations. The bones of cattle were far less 
resistant than those of horses. 


SYMPTOMS AND DIAGNOSIS — The symptoms are ex- 
tremely variable according to the nature of the fracture. While 
the complete fractures, especially the complicated, are easily 
recognized, the diagnosis of fissures is often very difficult. In 
general the following symptoms are characteristic of fractures 
in the domestic animals. 

I. Inability to support weight, aswellas pain 
when the animal is at rest or in motion, are the first visible 
symptoms of fracture of the bones of the extremities. Any 
sudden high-grade lameness in the horse, standing and trav- 
eling on three limbs, should cause suspicion of fracture. 
Horses and dogs stand and travel upon three limbs; horses 
either refuse to move or travel with great difficulty ; palpation 
causes crying in dogs. Many fissures are characterized by a 
line of pain along that of the fracture (pain-line in fissures 
of the first phalanx). Pain and disturbed function are often 
absent in fractures of the pelvis and ribs, in many fractures of 
the skull, as well asin fissures of the vertebrae. Total para- 
plegia and anesthesia are observed in fractures of the vertebral 
column. 

2. Abnormal mobility of the broken bones and 
limbs at the point of fracture is the most characteristic symp- 
tom. Abnormal mobility may be visible (pendulant position 
of the limbs, abnormal positions and relations), it may also be 
determined by palpation (fixation of the superior and inferior 
fractured ends). Abnormal mobility is usually absent in all Jn 
incomplete fractures, as well as in fractures of the pelvis and 
vertebral column ; in other cases the normal mobility of the 
limb may be restricted or suspended (impaction). 

3. Crepitation at the point of fracture, that is, a 
rough rubbing sound on palpation and passive movements of 
the fragments, is very characteristic; this is often a direct 


FRACTURKS 201 


pathognomonic sign of the existence of a fracture, especially a 
splinter-fracture. (One should be careful not to confuse this 
with arthritis and tendovaginitis crepitans). Crepitation fails 
in all incomplete fractures of the vertebral column, and in 
many fractures of the pelvis, as well asin marked dislocation 
of the fragments. 

4. Swelling in the vicinity of the broken ends is 
characteristic of simple fractures, it is due to rupture and sub- 
sequent hemorrhage in the adjacent soft tissues. Callus for- 
mation results in swelling in old and complicated fractures, 
especially when there is a phlegmonous inflammation of the 
soft tissues. Swelling is often absent in incomplete fractures. 

5. Injury to the skin, as well as a subsequent 
suppuration and fistula formation occurs only in com- 
pound fractures ; subcutaneous fractures seldom result in sup- 
puration, it may occur through the blood by means of a pyemic 
infection (strangles). 

Ompueranecement of the general condition 
seldom occurs in simple fractures; subcutaneous fractures 
that are characterized by severe hemorrhage and injury to the 
soft tissues may lead to a slight rise of temperature 
without other general derangement. The rise of temperature, 
which also occurs in animals, is termed an aseptic fever 
(in man subcutaneous fractures are usually followed by a tem- 
perature of 38.5-39.5). ‘This is explained by the presence 
of a ferment-like febrifacient formed from degenerated blood- 
corpuscles at the seat of fracture, this material is resorbed 
(v. Bergmann, v. Bruns, and others). Fever which 
follows complicated fractures, on the other hand, is usually 
septic because of the presence of pus cocci. Rupture of 
large blood-vessels by fragments of bones is followed by symp- 
toms of internal hemorrhage, this is especially true 
of pelvic fractures; severe crushing of the bone-marrow is 
followed by fat-emboli in the lungs and brain. 
In man, in addition to lipuria, albumenuria, and 
cylindruria resulting from fracture, there have mas ob- 
served brown cylinders, increase in the urobilin contents of 
the urine, and even hematogenous icterus as a result of the 
absorption of coloring matter from degenerated blood. 


202 FRACTURES — 


7. For many fractures certain specific individual 
symptoms areof diagnostic importance. Fracture of the 
nasal bones produces visible impressions, epistaxis, 
stenotic sounds, andeven permanent stenosis with 
dyspnea. Costal fractures lead to hemoptyeaus 
pneumonia, pleurisy, and injuries to the inter- 
costal arteries. Fracture of the sphenoid bone 
under certain circumstances, results in amaurosis, and 
dysphagia; fracture of the bones around the eve, phleg- 
mon of the orbit; fracture of the hyoid bone and max- 
illary bones, glossolysis, difficult mastication, 
and dysphagia. Chronic catarrh of the sutturag 
pouches has been observed after fracture of the hyoid bone 
(Siedamgrotzky, Rupprecht). Severe fractures of 
the cranial bones are followed by insensibility, nys- 
tagmus, hemorrhage from the ear (fracttre or 
the base of the skull and the temporal bone), as well as fatal 
paralysis of the brain; fracture of the cervical verte- 
bre, by paralysis of the diaphragm; fractureman 
the dorsal or lumbar vertebre, by fatal paraplegia, this 
is introduced by a sharply circumscribed motor and sensory 
paralysis, later it gradually becomes generalized. Healed 
fractures in the vertebral column produce deformities 
through the formation of anchylosis and synarthrosis (torti- 
collis, lordosis, kyphosis, scoliosis). Fractures of the last 
rib in the horse have occasionally resulted in injuries to 
the stomach and diaphragm (Grosswendt and 
others). Paralysis of the larynx resulted from a fracture of 
the first left ribin a dog (Frick). LaceratioOmegemes 
obturator artery is common in fractures of the pelvis; 
it results in internal hemorrhage. Fractures in the vicinity of 
the foramen ovale may result in permanent paralysis of 
the obturator, which leads to paralysis and atrophy of 
the adductors; the nerve becomes involved tn the callus 
(Thommassen). Fracture of the external angle of the 
ilium in a horse resulted in fatal laceration of the cir- 
cumflex artery (Kemp). Fatal laceration of the in- 
ternal thoracic artery in a horse has resulted from fracture of 


PROGNOSIS 203 


the sternum (Sand). In another horse with fracture of the 
eighth and ninth dorsal vertebrz there was pronounced per- 
Sspiration of the anterior regions which stopped in the 
immediate vicinity of the fracture (Bourgoin). In other 
horses with fractures of the vertebrz there are girth-shaped 
areas of perspiration in the lumbar region (Roder; personal 
observations). A horse with fracture of the right external 
angle of the ilium showed severe and permanent perspiration, 
as well as non-sensitiveness of the skin beneath the right hip. 
Vielaeroix ). 

RONTGEN RaAys.—The use of ROntgen Rays which 
has recently become of diagnostic value in the illumin- 
ation of fractures in man has been experimentally em- 
ployed in veterinary science (Bayer, Eberlein, Pfeiffer, 
Wensen, Hofiman, Troster, Kruger, and others). 
In the latter case it is not of general practicalimportance. The 
application of rays in living animals is frequently associated 
with great difficulties on account of the restlessnes of the 
animal. In addition to this is the high price of the apparatus 
(a Voltohm-apparatus for illumination of the horse costs 2500— 
2800 marks), as well as the complexity of manipulation. On 
the other hand, Rontgen rays may be employed in clinics, 
especially upon small animals (foreign bodies), as well as for 
the diagnosis of fissures and fractures of the bones of the 
extremities (first, second, and third phalanges). (For details. 
concerning the application of Réntgen Rays in veterinary 
science see my ‘‘Chirurgische Diagnostik der Krankheiten des 
Pferdes.’’ 1902). 

PROGNosIS.—When judging a fracture with reference to 
its healing or non-healing propensities the following factors. 
are brought into consideration : 

1. The species of the animal is of first importance in 
giving a prognosis. In horses and cattle fractures 
usually heal more slowly than in the smaller 
animals. Thecause is due, on the one side, to the fact that 
it is either very difficult or impossible to apply a bandage on 
a horse or a cow, the attempts at reposition and retention ot 
the fragments are frustrated. On the other hand, asa result 


204 FRACTURES 


of standing for a long time upon three limbs, severe inflamma- 
tion of the pododerm often develops in horses and cattle ; it 
begins with increased arterial pulsation and severe pain, and 
terminates with sinking of the os pedis and necrosis of the 
pododerm with a subsequent septicemia (pressure lamiunitis). 
Remaining for a long time in the recumbent position also pro- 
duces contusions and decubital gangrene of the skin with 
general sepsis because of the great body-weight of these 
animals. According to the experience of the Prussian Army 
only 20 to 25 percent of all bone-fractures in the horse are 
curable ; of 3473 covering a period of ten years from 1886— 
1895, 744 healed : equal to 22 per cent. On the other hand, 
according to my experience among dogs, the total number of 
healed fractures amounts to about 85 per cent. The prog- 
nosis of fractures in the dog, therefore, 1s eum 
times.as favorable as in the horse. The per 
centage of healing in birds is still higher. Also in swine, rib- 
fractures especially, appear to heal very rapidly. The time 
required for fractures to healin horses and 
cattle averages from one to three montis 
the dog and sheep, three to four wee see 
birds, fourteen days. 

2. The bone itself, from a prognostic standpoint, is of 
great importance; one bone may heal very readily, another 
with great difficulty, many seldom heal. In fully developed 
horses and cattle the following fractures are usually incura- 
ble: fractures of the cervical vertebre, dorsal vertebre, and 
lumbar vertebrze when the body or arch is involved and leads 
to injury of the spinal marrow ; complicated (in most cases the 
simple also) fractures of the femur, tibia, scapula, humerus, 
and radius; comminuted fractures of the first and second 
phalanges, as well as many fractures of the pelvis. , Fractures 
of the metacarpus and metatarsus heal with great dif- 
ficulty. The following, however, are relatively cure- 
able: fissures, simple fractures of the ribs, fractures of the 
external angle of the ilium, those in the vicinity of the eye, 
simple fractures of the first and second phalanges, and caudal 
vertebrze, as well as the vertebral processes. 


PROGNOSIS 205 


3. The kind of fracture isalsoof great importance 
from a prognostic standpoint. In general the follow- 
fweare uniavorable: comminuted fracture, 
splinter and complicated fractures, as well as 
Mieco ich involve a,joint or occuri\in its 
immediate vicinity (glenoid cavity).° Simple 
fractures, on the other hand, are relatively favorable. The 
prognosis is also unfavorable in non-recent fractures which are 
first brought for treatment some time after they occurred. 
Fractures of the diaphyses heal more readily than those of the 
epiphyses ; transverse fractures more readily than the oblique. 
Healing is delayed when the patient suffers from internal 
disease. Fractures in the vicinity of the joint occasionally lead 
to anchylosis (fetlock-joint, coronary-joint, pedal-joint). The 
prognosis of partial fractures is especially favorable, for exam- 
ple, fracture of the lateral tuberosity of the humerus, or the 
oblique processes of the cervical vertebree. In general, fissures 
are more favorable than complete fractures. The prognosis 
of many fissures, on the other hand, has been found to be 
unfavorable. The process of healing seems to be very slow, 
especially in fissures of the first phalanx of the horse (six to 
twelve weeks and over). Fissures of the vertebral bodies are 
mainly incurable. 

4. The age of the animal has an influence on the prog- 
nosis, experience has shown that the healing of bones 
proceeds more slowly in old animals than in 
young. Young animals can remain standing or recumbent, 
without danger, for a longer time than those advanced in 
years. 

Finally, in horses and cattle, in addition to the points 
already discussed, one must decide whether the patient is worth 
treatment from an economic standpoint, or whether it would 
not be better to slaughter the animal. 


CURABILITY OR INCURABILITY OF A FRACTURE.—The answer to 
this question belongs to one of the most difficult problems with which 
the practicing veterinarian has to deal. Because the question must fre- 
quently receive an immediate answer (on the race-track for instance) a 
careful consideration of the previously considered influences is neces- 
sary. In particular, one must not forget to compare the value of the 


206 PROCESS OF HEALING 


‘patient with the cost of treatment—that ‘is, the resulting permanent 
diminution in the usefulness of the animal. In doubtful cases, espec- 
ially in cattle, one should advise slaughter. In certain cases, when the 
patient is a valuable breeding-animal, treatment until birth of the 
young may be advised. Cows advanced in pregnancy may be killed 
when suffering from incurable fractures of the pelvis: perform lapa- 
rotomy immediately after slaughter and extract the young through an 
incision in the uterus (Cesarian section ). 

From a forensic standpoint also, it is often difficult to render 
an opinion with reference to the curability of a fracture. In Prussia 
many verdicts are rendered through the knackers privilege by 
which the knacker has the right to reclaim for himself incurable 
‘cattle. Occasionally these questions must be decided with careful ref- 
erence to the existing conditions, especially to the seat and kind of 
fracture. In general the previously explained conditions are sufficient. 
One’s verdict is controlled by the average statistics furnished by expe- 
rience (‘‘as a rule’’ curable or incurable). 

It has been observed many times in horses and cattle, that, excep- 
tionally, fractures witha very unfavorable prognosis may heal. Finally, 
not all cases recorded in veterinary literature are free from exception : 
Poschl healed a complicated fracture of the inferior third of the 
femur in a thorough-bred stallion in eight weeks (?), A complicated 
fracture of the patella, which was broken in three pieces, healed in a 
horse in two months with the formation of a bony callus; lameness re- ~ 
mained which was severe when the animal trotted and slight during 
walking movements (Andrieu). A pelvic fracture, which involved 
fracture and displacement of the acetabulum healed in a cow (Berdez). 
A separation of the pubic symphysis after difficult parturition in a cow 
healed in four weeks, and twice afterwards the cow gave birth to calves 
(Henninger). A bilateral complicated fracture of both inferior 
maxillz at the interdental space healed in fifty days ina horse (Pas- 
serini). A fracture of the trocanter of the femur healed in a two- 
year-old foal (Neuberger). I, myself, have observed healing in 
two different cases of fracture of the lateral tuberosity of the humerus, 
as well as in two fractures of the scapula, in fully developed horses. A 
transverse fracture of the metacarpus of the horse healed in sixty-six 
days (Pujos); complete healing occurred in a similar manner in 
fracture of the radius of a horse (Schafer, Salchow, and others). 
In a four-year-old colt healing of a complicated fracture of the femur 
took place in the slings in four months without the use of a bandage; a 
piece of the middle trocanter was discharged from an abscess (Brauer), 
A fracture of the metatarsus in a colt four days old healed under a plas- 
ter bandage in five weeks, similar healing occurred in a fracture of the 
radius and ulna in a foal eight weeks old (Frank ). 


PROCESS OF HEALING IN SIMPLE BONE FRACTURES.— 


FRACTURES 207 


Healing of simple subcutaneous bone-fractures occurs through 
an aseptic inflammation very analogous to that of primary 
healing of skin wounds. ‘The uniting of the broken ends of 
bone is due, partly to the regenerative activity of the peri- 
osteum, partly to that of the bone-marrow. The 
essential portions involved in callus formation are only the 
connective-tissue, soft portions of the bone (periosteum, end- 
osteum.); the tela ossea plays no part. Alsothe effused blood 
at the point of fracture, as well as the neighboring soft tissues 
are not involved in the process of healing. ‘The union of the 
fragments follows the formation of granulation-tissue, which 
subsequently ossifies, the so-called callus, the granulation- 
tissue is formed from the periostewm and bone-marrow. The 
bone-callus is the product of an ossifying 
periostitis and osteomyelitis. In this formation 
one distinguishes various forms of callus : 

1. The external callus or periosteal callus 
is due to the activity of the osteoblasts situated in the deep 
layer of the periosteum. | 

2. The inner callus or marrow callus (endosteal 
callus, myelogenous callus) is an analogous product of the 
osteoblasts of the bone-marrow. 

3. The middle or intermediate callus lies mid- 
way between the external and inner callus, and is considered 
as principally a continuation of the external callus, secondarily 
a product of the vessels of the Haversian canals (endothelial 
proliferation ). 

Finally, one distinguishes between a provisional and 
definitive callus. The provisional callus forms a rela- 
tively soft, spongy, extremely voluminous, newly-formed mass 
of bone. The definitive callus is formed later from the provi- 
sional callus asa hard, small, bony cicatrix. 

Microscopic CHANGES OF CALLUS FORMATION. Ac- 
cording to histological and experimental investigations especi- 
ally those of Virchow, Billroth, v. Volkmann, 
P. Bruns, Ziegler, and others the following changes 
occur; as in primary aseptic healing of wounds, there first 
occurs a cellular infiltration at the seat of fracture, as well as 


208 FRACTURES 


the formation of acellular and highly vascular embryonic or 
granulation-tissue (the callus), this proceeds from the perios- . 
teum as well as from the bone-marrow. During the process 
two phases are recognized ; namely, the stage of ossifica- 
tion of the callus, and the stage of retrogression 
OTe Cires Caries 

I. Ossification of the callus, the result of the 
ossifying periositis and osteomyelitis, proceeds, according to 
recent investigations, as follows: a cartilaginous cal- 
lus is first formed from the inner’ la yeu 
the periosteum, this is ossified asthe result 
of a-direct transformation of the Catt. ge 
into bone. (The osteoblasts play only a secondary role in 
this process). Within three or four days after the 
fracture small foci of osteoid tissue begin to form in the 
embryonic tissue in the vicinity of the fracture, they form a net- 
work of osseous trabecule with inclosed marrow cavities. In 
the second week the periosteal callus is a reticulated and 
tolerably soft tissue. From the end of the third week it 
develops into a firm, spongy callus-substance, rich in marrow, 
the provisional callus. 

2 Retrogression of the callus begins in the 
fourth to the fifth week with obliteration of the 
newly-formed vessels. The resorbing activity of the osteo- 
clasts (CO,) liquefies the bone in the form of small spaces. 
Small foci of necrosis occur in simple bone-fractures as a result 
of derangements in the circulation at the line of fracture and 
its immediate vicinity, this necrosis must also be removed by 
lacunar resorption. At the same time the soft and uneven 
provisional callus is reduced toa hard, smooth, bone-cicatrix— 
the definitive callus—so that the previously thickened surface 
of the bone is apparently smooth again at the point of fracture, 
and the bone-cicatrix can hardly be seen, or recognized by 
palpation. 

Callus formation is assisted by the administration of small 
doses of phosphorus (horse, centigram; dog, milligram). These 
small, continually administered doses of phosphor. 


us produce a specific formative stimulus on the 
bone-tissue which results in an acceleration of its 


ABNORMAL CALLUS FORMATION 209 


growth. The exact changes which occur have been experimentally 
demonstrated by Wegener (Virchow’s Archiv. 1872) through the 
continual feeding for months of milligram doses jof phosphorus to 
young rabbits, hens, cats, dogs, and calves, as well as to adult animals. 
The following are the changes which occur: at areas where the cartilage 
normally developed into reticulated spongy substance, with abundant 
red marrow-tissue and rich blood-supply, there was formed compact, 
firm and hard bone-tissue with rapid transformation of cartilage to bone- 
cells ; this was especially true of the long bones, vertebre, ribs, pelvis, 
and the bones of the carpus and tarsus. The cause is due to a narrowing 
(schlerosis) of the smallest bone-canals (canaliculi); the result is a 
thick, firm, schlerotic bone-cortex. . The development of the periosteum 
is also accelerated, the product, likewise, of a firm schlerosis. The 
intermediate epiphyseal cartilage undergoes more rapid ossification. 
Finally, the marrow cavities become stenosed and eventually disappear. 
Wegener’s theory was investigated by Kissel (Virchow’s Archiv. 
1896) ; it was confirmed, however, by Stubenrauch (Berlin Surgical 
Congress 1900). 

ABNORMAL CALLUS FORMATION.—1I. Retardation of 
the previously described callus formation results from splinter- 
ing of the bone, pronounced dislocation of the broken ends, 
interposition of the soft tissues, continued movement of the 
broken fragments (faulty bandage or lack of bandage), general 
diseases (osteomalacia, rachitis, infectious diseases, constitu- 
tional weakness), as well as infection of the broken areas 
(compare with healing of compound fractures). Subcutaneous 
splinter-fractures usually heal, small splinters may even be 
completely resorbed, necrosis occurs only as a result of subse- 
quent infection (formation of a sequester). 

When callus formation fails to produce firm union between 
the fragments, there exists a so-called false joint (pseudo- 
arthrosis), that is, a permanent moveable union between 
pieces of bone. This is especially observed on the head and 
neck of the femur, on the first phalanx, and on the posterior 
false ribs. 

2. Acallus which is abnormally large is termed 
meuypertrophic callus or: callus luxutians. 
Hypertrophic cicatrix and callus luxurians correspond to ex- 
cessive wound granulations; the so-called callus tumors 
have their analogues in the keloids and are usually osteomata 
or enchondromata, seldom osteosarcomata. When two bones 


210 FRACTURES 


lying parallel to each other are firmly united by a callus forma- 
tion, as is observed in the fracture of two ribs, there exists a 
synostosis. ‘The bony, immobile union of two bones in a 
joint is termed anchylosis (anchylosis ossea). If the 
callus is not composed of bone-tissue, but of connective tissue, 
failure of ossification of the periosteal and myelogenous ger- 
minal tissue, it is termed a callus fibrosus. ‘This is 
observed in the fracture of short, non-vascular bones, especially 
the patella, navicular bone, sesamoids, the olecranon, calca- 
neum, pisiform bone, the body and coronoid process of the 
inferior maxilla, and the false ribs. 


TERMINATION OF FISSURES AND FRACTURES OF LONG STAND- 
ING.—In the light of previous statements it is not difficult to imagine a 
fresh fracture resulting from an:old fissure.” Kore 
forensic verdict it should be remembered that a fracture is preceded by 
an old fissure or fracture only when granulation-tissue or callus forma- 
tion is present at the margin of, or in the vicinity of the fracture. The 
age is determined according to the condition of the callus (see above), 
Fresh fissures and fractures present nocallus formation but hemorrhage, 
and the appearance of a fresh, aseptic inflammation. It is further ob- 
served that a fissure, sometimes very early, at other times only after a 
long period, may be transformed intoa fracture. The smooth or uneven 
condition of the broken surfaces is of slight importance for the determi- 
nation of the age of a fracture. A smooth broken surface, without 
other symptoms, does not indicate an old fracture; experience has 


shown that the surface, and edges of the broken surface may be worn 


smooth within the first half hour after the occurrence of the fracture 
(Gunther). Trasbot treated a case of fracture of the tibiain a 
horse which first became apparent seven days after the occurrence of 
the fissure; a two or three mm. thick layer of young, very vascular, 


spongy bone-tissue was present on the broken ends. The bone-marrow . 


was strongly injected, the compact bone-tissue could be easily cut. 
On microscopic examination the Haversian canals were found dilated 
and filled with round-cells. I investigated a case of fissure of the ver- 
tebra in a horse in which only soft granulation-tissue had formed at the 
seat of fracture after twenty-nine days, there was no callus formation. 
PRocESS OF HEALING IN COMPLICATED BONE FRAc- 
TURES.—While the simple, subcutaneous bone-fractures heal 
per prima through an aseptic ossifying periostitis and osteomye- 
litis, complicated fractures lead to suppuration of the broken 
ends with callus formation. The prognosis of a complicated 
fracture depends upon the following conditions : duration of the 


TREATMENT 211 


active influence of the pus-bacteria, age of the fracture, the 
extent of injury to the skin and surrounding soft tissues, as 


well as the extent of bone-splintering. With slight injury to 
the skin and soft tissues combined with careful disinfection of 


the wound, healing proceeds nearly as fast as in simple bone- 


fractures. With reference to the severity of a complicated 
fracture, the splintering is of less importance than the degree 


of injury to the soft tissues. A smooth fracture with- 


Mireesplintering of the; bone; but with a large 


skin-wound and extensive injury to the soft 


tissues is far more severe than extensive splin- 


terns with only slight injury to the soft 


parts (Tillmanns). 
The local changes in the broken area of a complicated 
fracture, consist, in addition to the changes described under 


callus formation, in inflammatory swelling, sup- 


puration, burrowing of pus, phlegmon, phle- 
bitis, lymphangitis, septic processes, ichor- 


ous changes in the soft tissues, suppurative 


periostitis and osteomyelitis, necrosis of the 
bone (sequestration) and fistula formation; as 


a result of general infection septicemia and pyemia may follow. 


TREATMENT OF SIMPLE BONE-FRACTURES.—The first 


surgical problem consists in reposition (reduction) that is, 


dim 


‘rearrangement and replacement of the dislocated ends in their 


normal position by means of a pull (extension) and a 


-counter-pull (contra-extension); the second consists in 


retention, that is, fixation of the arranged fragments by means 


-of a bandage. Callus formation only follows accurate reposi- 


tion and complete rest for the broken ends. In many of the 
large animals, and in many fractures (ribs, pelvis, heads of 
bones), it is impossible to fulfill both conditions ; certain frac- 


tures, however, heal in the absence of reposition and retention 
‘simply through. natural healing, this is especially true of rib- 


fractures and many fractures of the pelvis. In small animals, 


-on the other hand, especially in dogs, reposition and bandaging 
is usually possible. 


The application of the bandage in simple bone-fractures, 


Zi FRACTURES 


as well as the materials employed for this purpose have already 
been described in a previous hand-book (Bayer, ‘‘Operations- 
lehre’’). I, myself, employ plaster-of-Paris bandages exclus- 
ively in horses and dogs, and consider other forms of bandaging 
material (tripolith, silicate-of-potash, gutta percha, lime, rub- 
ber, starch, dextrin, pitch, paste-splints, wooden splints, 
splints of iron and celluloid), as, at least, superfluous. Under 
certain circumstances they may be employed as an emergency 
bandage. The plaster-of-Paris bandage is applied as follows: 
after reposition is complete the broken ends of the limb are 
firmly fixed above and below by one or two attendants ; thin 
layers of padding are applied, especially at the seat of frac- 
ture, so that the broken ends are well bolstered ; a cambric or 
flannel bandage is applied over the whole. For horses the 
application of padding may be omitted. Over this bandage 
are then applied the turns of plaster bandage which have been 
previously prepared from fresh plaster and soaked for a short 
time in warm water. It must be applied in such a manner 
that a uniform and extensive layer of plaster comes in contact 
with the broken area and its vicinity. The bandage may be 
strengthened by applying some of the prepared plaster in the 
form of a paste. The following general rules must be 
observed when applying a plaster bandage : 

1.: The bandage must not exert {o0;gmeam 
pressure nor form cord-like consti fej 
One should also observe that the folds of the plaster bandage 
are not too large or unequal. 

2. The bandage should be inspected madame 
with special reference to pressure aimee 
striction. In dogs the paw of the involved limb should 
receive special attention with reference to swelling, blue color- 
ation, and necrosis. In these cases the bandage must be 
loosened, or entirely removed. 

3. The bandage, on the other hand, must 
not be applied too loosely. The swelling which 
occurs the first few days after fracture disappears as a result 
of the resorption of the exudate ; the bandage, though properly 
applied, becomes loosened, and must then be renewed. In 


FRACTURES 213 


such cases a provisional bandage may be employed for the first 
few days, until the swelling has diminished. 

a. opecialcareisrequired inthe applica- 
tion of a padding over the seat of fracturein 
dogs. In the following areas there is great danger from 
pressure necrosis as a result of faulty padding : the skin over 
the olecranon and os calcis, as well as upon the bony processes 
of the carpus and tarsus. Necrosis is characterized by fetid 
odor and fever, as well as general disturbances. In such cases 
the bandage must be immediately removed and the contused 
area treated with antiseptics. 

Re bLhe retention of bandages to the ex- 
tremities of dogsis maintained by passing a 
plaster-saddle over the back or thorax sothat 
it passes down on the opposite side. This 
method prevents falling down and tearing of the bandage. 
The plaster-saddle is especially useful in fractures of both 
anterior and posterior limbs. 

6. When possible, the neighboring joints 
muove and below the fracture are included in 
the bandage. ‘This favors immobility of the fractured 
area. 

7, After the application of the bandage 
the animal is kept as quiet as possible until 
time for removal. Horses are best retained in slings or 
tied high, and given plenty of soft bedding ; dogs are locked 
up. Cagny healed many fractures in dogs by merely lock- 
ing, without bandage, ina very narrowcage. The bandage 
may be removed from dogs after three or four weeks; upon 
horses it should remain six to twelve weeks. 


Application of bandages recently employed in a man by means of 
which the patient may move about, and thus prevent severe muscular 
atrophy and general derangements, are not applicable to the lower ani- 
mals, Callus formation, on the other hand, may be promoted in the 
lower animals by the internal administration of phosphorus. In the 
horse the dose is one one-hundredth to five one-hundredths grams; in 
the dog, one half to two milligrams. Neurectomy as a last resort 
may be employed where lameness remains as a result of fracture of the 
first, second, or third phalanx. 


214 TREATMENT 


TREATMENT. OF COMPOUND FRACTU RES.—Because of 
the existence of an open wound, treatment is essentially dif- 
ferent from that of a subcutaneous fracture. In contrast to 
the pre-antiseptic times, with the introduction of aseptic and 
antiseptic methods, and with the results of experience ob- 
tained during the past ten years in the surgery of war 
(v.Bergmann and others) the prognosis of compound 
fractures, which were formerly treated almost exclusively by 
amputation, has become far more favorable. In human sur- 
gery, from a therapeutic standpoint, one distinguishes four 
varieties of compound fracture : 

1 Whenthere exists only atrivial, fresh 
perforation of the skin by a pointed fragment 
of bone (penetrating fracture) a so-called asep- 
tic, plaster-of-Paris occlusive bandage was 
applied. Aseptic occlusion is produced as follows: careful dis- 
infection of the skin, reduction of the perforating fragments of 
the fractured bone, application of an evenly applied aseptic 
bandage over the fractured area, the whole is then enveloped 
in a plaster bandage which remains in position until healing is 
complete. 

2. Plaster-of-Paris bandages cannot be applied in the 
following cases: recent compound fractures with 
extensive injury to the skin or soffipanaae 
especially with splintering; or “rama 
which produce an open joint. Such fractures are 
treated as follows: carefully disinfect according to the rules of 
antisepsis ; remove all lacerated tissue, blood clots, bone- 
splinters, and foreign bodies, very sharp fragments may 
be removed with the forceps ; ligate bleeding vessels ; enlarge 
the skin-wounds until the broken ends are freely visible; 
carefully irrigate the cavity of the wots 
provide drainage, and insert a tampon of iodo- 
form gauze; in certain cases the skin may be partially 
sutured, an aseptic bandage is then applvedg 
this is changed according to the demands 
of each case. A plaster bandage showhaaiae 
applied only after complete healing Of @eume 


FRACTURES 215 


wound. A plaster bandage with a window is applicable 
only to small injuries ; through the window in the cast the 
wound is treated with aseptic bandages. 

3. Old—more than one ortwo days—suppu- 
rating, complicated fractures, especially those in 
which there exists an ichorous wound secretion, gangrenous 
decomposition of the tissues, as well as septic phlegmon in the 
vicinity of the fracture, must be treated with energetic disin- 
fection. When necessary open incisions may be made, 
they are best treated with permanent antiseptic ir- 
rigation. | 

4. With extensive crushing and bruising ofthe 
entire fractured area, as well as with imminent septic general 
infection from an extensive, suppurating and ichorous frac- 
tured wound, when local treatment cannot be employed be- 
cause of danger to the life of the patient, amputation of the 
entire limb remains as a last resort. In general, amputation 
is indicated in both the above named conditions. In veteri- 
nary practice its use is restricted to dogs. 

Fixation of the fragments with ivory nails or by means of 
bone-sutures, employed largely in human surgery, are also 
applicable to small animals, as well as to fractures of the 
inferior maxilla in the horse. 


PROPHYLAXIS OF BONE FRACTURES.—In horses, prevention of 
fractures while casting forms an important surgical 
problem. Fractures of the vertebral column, femur, or pelvis may 
occur. While the pathogenesis of these individual fractures is treated 
in text-books of special surgery, the following remarks concerning their 
prevention find place here: 


1. Fractures of the vertebrae occur most often while cast- 
ing old horses and thoroughbreds. In old horses the causes are due toa 
senile atrophy of the bone, a rarefying ostitis, or an anchylosis of the 
vertebral joints. While palliative methods are not applicable, one 
should observe the following principles: when possible, operate 
old horses standing (tooth operations), cast the animal | 
only when absolutely necessary. In thoroughbred animals 
casting for castration, especially, affords an opportunity for the existence 
of spontaneous fractures as a result of excessive contraction of the longis- 
simus dorsi and ileo psoas, thereby producing excessive flexion of the 
vertebral column. Prophylaxis consists ina previous weakening 


216 INFLAMMATION OF BONE 


of the animal: light diet, exhaustion by high-tieing and over- 
exercise, administration of laxatives (arecalin, eserine), subcutaneous 
injections of m O rphine, clysters of chloral hydrate (75-150 
grams); further, the application of a dorsal girth previous 
to casting, with the greatest possible extension of the neck and 
head while in the recumbent position; in prevention of lateral 
movements by the application of a crupper and fixation of the head, 
in the application of a twitch or the use of chloroform. 

2. Fracture of the femur is favored by struggling in the 
hopples, firm fixation of the upper limb in an abdominal girth, as well 
as permitting the limb to pass too far forward. Struggling against 
fetlock straps is prevented by a twitch on the limb. When tieing the hind 
limb it should be excessively flexed (Danish method), or allowed 
a certain amount of mobility (Berlin method). Care should 
be taken that the foot is never carried forwards 
outward overthe elbow-joint. Further, one appliesa nasal 
twitch, or chloroforms nervous horses. 

3. Pelvic fractures are caused by throwing on hard ground. 
They are easily prevented by providing a thick layer of straw. 

From a forensic standpoint the facts mentioned are of great im- 
portance. If an operator isable to maintain that previous to casting and 
during the operation, the above named prophylactic methods were ac- 
curately and thoroughly carried out, that he employed suitable casting- 
apparatus, and gave accurate instruction to the attendants, he is in no way 
responsible if fractures do occur. Such fractures occur re- 
gardless of the most careful prophylaxis, and without 
any fault or responsibility on the part of the operator. 
My experience has demonstrated that special precautions by means of 
a girth along the back, Bernadot and Butel’s apparatus 
do not always prevent fracture of the vertebre. I must, therefore, 
contrary to the statements of others, coincide with Moller ’s 
opinion that casting horses is always associated with 
a certain amount of danger. 


II. ‘INFLAMMATION OF BONE, PERIOSTITIS, OSTITIS, 


OSTEOMYELITIS. 


CLASSIFICATION.—Inflammation of bones, as well as in- 
flammation of other organs, may be classified from various 
standpoints. ‘The following forms are differentiated : accord- 
ing to the course, acute and chronic; according to the 
cause, traumatic, spontaneous, hematogenous, 


PERIOSTITIS 217 


and specific (tubercular, actinomycotic, botryomycotic, 
pyemic, glandular), primary and secondary (symp- 
tomatic, metastatic); bacterial (septic), and non-bac- 
terial (aseptic) ; finally, according to the character of the 
inflammatory product—suppurative, ossifying, 
fibrous, granular, and necrotic inflammation of 
the bone. From a standpoint of practical surgery they are 
classified from an anatomo-physiological standpoint with refer- 
ence to inflammation of the periosteum, genuine bone-sub- 
stance, and bone-marrow. While in man, hematogenous infec- 
tion and inflammation of the bone-marrow is by far the most 
important form of inflammation of the bone, in veterinary 
science this is not true. In animals, inflammation 
of the periosteum holds the most important 
position. This is especially true of horses where the 
periosteum, as an external covering of the bone, is exposed to 
many traumatic insults. 

In text-books of veterinary surgery osseous inflammations 
are arranged as follows in the order of their importance : 

1. Inflammation of the periosteum (peri- 


ais ets), 
> *intiammation of the bone-substance 
{ostitis). 


Gelutlammatton of the bone-marrow 
(osteomyelitis). 


I. INFLAMMATION OF THE PERIOSTEUM, PERIOSTITIS. 


Forms.—According to the causes, course, and inflamma- 
tory products, and above all, with reference to the treatment, 
the following forms of periostitis are recognized : 

a) Acute non-suppurative periostitis, which 
is also termed aseptic, traumatic inflammation of 
bone. It is not due to the action of bacteria, but to mere 
traumatic irritants (contusions, pressure, blows) acting subcu- 
taneously. Anacute, aseptic periostitis develops, for example, 
as the immediate result of a subcutaneous bone-fracture. The 
ordinary causes in horses are kicks, blows, treads on the 


218 PERIOSTITIS 


coronet, pressure on the interdental space, and collisions; the 
inflammation, therefore, is usually circumscribed. As the 
periosteum is a membrane having a very rich nerve-supply, 
recent cases of inflammation are characterized by extreme 
pain on palpation, lameness, a circumscribed semi-soft 
swelling, andheat. Treatment consists in the appli- 
cation of moist warmth, Priessnitz bandages, massage, 
application of camphor, iodoform, and iodine ointment or 
grey mercurial ointment. Ordinarily the acute form passes 
into the following form ; into a chronic ossifying periostitis. 
b) Chronic ossifying periostitis develops from 
the preceding. It is located in the deeper layer of the perios- 
teum, through the ossifying activity of this layer the inflam- 
matory product is transformed to bone. Callus formation in 
simple bone fracture is a typical example of ossifying perios- 
titis (see page 206). In the same way there develop from 
the circumscribed, acute, non-suppurative periostitis, chronic 
inflammatory new formations of bone which are termed 
osseous proliferations or exostoses (osteophytes, 
hyperostoses, supraossa). In the horse this is the most im- 
portant form of inflammatiori of the bone, and one of the most 
frequent of bone diseases. It is especially frequent on the 
inner surface of the metacarpus, in the region 
of the coronary-joint (ringbone, pseudo-ringbone ; 
the exostoses correspond to the attachments of capsular and 
lateral ligaments), in the region of the tarsal-joint 
(spavin, lateral exostoses), as well as on the inferior 
maxilla (pressure on the interdental space; pressure 
from the manger on the inferior margin)>) {ig 
these cases the exostoses are due to chronic, frequent- 
ly-repeated, traumatic irritation of the periosteum, as in 
ringbone caused by a continual unilateral strain on the 
ligaments due to an abnormal position of the hoof. The fre- 
quent occurrence of exostoses on the inner surface of the met- 
acarpus is partially referable to a unilateral strain on the 
periosteum between the metacarpus and splint bone. Of 784 
exostoses, not less than 651 (83 per cent) were on the inner 
surface (374 left, 277 right; Preussische Militar- Veterinar- 


PERIOSTITIS 219) 


Berichte 1886 to 1895). According to Zschokke seventy- 
five per cent of all adult horses suffer from exostoses on the 
metacarpus, ninety-three per cent are located on the inner 
surface. Inasimilar manner Zschokke found that sixty 
per cent of all adult horses are affected with exostoses at the 
fetlock (pseudo-ringbone). One also finds exostoses on the 
humerus inchronic bursitis intertubercularis, in the alveoli 
of the teeth in chronic alveolar periostitis (adhe- 
sion between the teeth and the alveolar wall, difficult tooth- 
extraction), as well as on many bones in the form of so-called 
murtiple, symmetrical exostoses and hypeér- 
ostoses. A multiple exostosis formation in dogs has been 
described by Kitt; many of the bones, especially the inferior 
maxilla, the radius, and the bones of the lower limbs presented 
bony exostoses which clearly corresponded to muscular attach- 
ments. He considered it a multiple hyperplasia of the bones 
of myopathic origin, caused by muscular strain, and apparently 
influenced by a pathogenic predisposition. Occasionally exos-. 
tosis formation leads to anchy1osis—that is, osseous. 
adhesion between two joints (spavin, ringbone, vertebral col- 
umn), as well as to synostosis (bony adhesions between 
the metacarpus and splint bones). Treatment of ossifying 
periostitis consists in the application of blisters, firing, perios- 
teotomy, and neurotomy. Many exostoses gradually 
diminish in size, occasionally they completely 
disappear. 

c) Acute suppurative periostitis is usually due 
to an external injury (bone-wound, compound fracture) 
whereby pus-forming bacteria gain entrance to the periosteum. 
The cause of the infection rarely gains entrance through the 
blood-stream (metastatic), or extends from a suppurative 
inflammation of the bone-marrow ; in the latter case there exists. 
a so-called subperiosteal abscess. Treatment 
consists in incision and antiseptic irrigation. 

d) Chronic suppurative periostitis develops from 
the preceding. It often leads to osteomyelitis, necrosis of the 
bone, and fistula formation. It is most frequently observed as. 
a sequela of a complicated fracture (fistula of the rib, pelvic 


220 OSTITIS 


fistula, sternal fistula), asa result of pressure on the inter- 
dental space, as well as in alveolar periostitis (tooth-fistula, 
empyema of the superior maxillary sinus). Treatment is 
operative (incision, curettage, trepanation, tooth-extraction). 


The chronic fibrous periostitis isa chronic inflammation of 
the external, connective-tissue layer of the bone, which, in contrast to 
the deeper layer of the periosteum, contains no osteoblasts. It leads to 
the formation of so-called periosteal callosities with a subse- 
quent atrophy of the bone. It occurs in the horse on the bridge of the 
nose asaresult of pressure from the nose-band, it also results from 
pressure on the interdental space. 


2. INFLAMMATION OF THE BONE-SUBSTANCE. OSTITIS: 


Forms.—Inflammation of the tela ossea occurs in the 
marrow tissue and in the vessels of the Haversian canals, as 
well as in the bone-substance lying directly over these areas ; 
it may also occur in the marrow spaces of the spongy bone. 
The ostitis is usually chronic and is due, either to external 
irritants, especially pressure and contusion (spavin, articular 
ringbone), as well as compound fractures; or to specific 
inflammatory irritants (actinomycosis, glanders). It may also 
result from extension of inflammation from the periosteum or 
bone-marrow ; it is seldom of hematogenous origin. The 
following forms are recognized : 

a) Rarefying ostitis, that is, an inflammation of the 
bone characterized by atrophy of the bone-substance (oste- 
oporosis) with the formation of hollow spaces (lacunz). 
The atrophy of the bone is the result ofa lacunar bone- 
resorption. ‘The initial stages of spavin and ringbone are 
typical examples of rarefying ostitis in the horse, it is due to 
severe, continued contusion of the bones of the tarsal-joint, 
and the bones of the first and second phalanges as a result of 
overexertion of the horse. Rarefying ostitis has been recently 
demonstrated as a cause of idiopathic fractures of the first 
phalanx, second phalanx, and other bones (fragilitas ossium) 
of the horse (ostitis of fatigue). Actinomycosis of the interior 
maxilla in cattle presents a combination of rarefying ostitis and 
ossifying periostitis. The transformation from a provisional toa 


OSTEOMYELITIS 221 


definitive callus in fractures is characterized by a rarefying 
ostitis. Demarking inflammation of the bone in sequestration 
is a similar process. Finally, many consider osteomalacia a 
chronic rarefying ostitis with a consecutive decalcification of 
the bone. 

b) Condensing ostitis is a process directly opposite 
to the preceding. Instead of atrophy it leads to new forma- 
tions, induration, and thickening of bone (osteoschlerosis, 
schlerotic ostitis, eburnation). It is observed as 
a form of cicatrization at the termination of callus formation, 
in the latter stages of spavin, in the vicinity of bone-fistulze 
and bone-sequesters (inferior maxilla), as well as after the 
administration of small amounts of phosphorus. 

Pees rantiar or funeoid ostitis is characteristic 
of tuberculosis of the bones. It is of a hemato- 
genous origin and in combination with a granular osteomye- 
litis leads to the formation of tuberculous granulation-tissue 
and to a suppurative liquefaction of the bone (caries). For 
details concerning tuberculosis of the bones see page 171. 
Many forms of arthritis and glanders of the bone lead 
to similar processes. Zschokke has observed a case of 
glandular ostitis of the sternum with chronic fistula formation 
and perforation of the sternum (pleuritis). 


Deforming ostitis is a chronic inflammation of the bone. In men 
the following bones are most often diseased: long bones, the 
cranium, the vertebre, and the pelvis. The disease may be painful or 
painless, it leads to hypertrophy, softening, and bending of the bones. 
S pavin inthe horse may be termed a deforming ostitis. 


3. INFLAMMATION OF THE BONE-MARROW. OSTEOMYELITIS. 


ForMS.—One recognizes, as in periostitis, an ossifying 
anda suppurative osteomyelitis. The first occurs 
during the process of callus formation in simple fractures ; the. 
second in healing of compound fractures. In addition to 
these, suppurative inflammation of the bone marrow may have 
hematogenous origin through the entrance of pus-bacteria 
from the blood (pyemia, foal-lameness, chronic swine-erysipe- 
las, leukemia, intravenous injections of streptococci, cocci of 


222 OSTEOMYELITIS 


contagious pleuropneumonia, bacteria of chicken-cholera, etc., ° 
in serum horses). Granularosteomyelitis in tubercu- 
losis of the bones is an example of this form. One further distin- 
guishes a non-suppurative inflammation of the bone-. 
matrow (serosa, albumenosa, or mucHuiGae 
non-purulent osteomyelitis) with a non-suppu- 
tive but sanguino-serous, muco-viscid, synovial-like exudate, 
which may be due to various causes. In animals one most 
frequently observes a suppurative inflammation of 
the bone-marrow after compound fractures 
of the long bones, as well as in connection with sup- 
purative alveolar periostitis, it leads to the formation of 
bone fistulae, bone-abscesses, and necrosis 
Crore moO ey 

PRIMARY OSTEOMYELITIS IN MAN.—In men, acute 
primary infectious osteomyelitis is the most 
important form of inflammation of bone. ‘This is also termed 
a spontaneous diffuse osteomyelitis or bone typhus. It is 
found especially in young individuals and has been recently 
considered a pyemic osseous affection of developing 
bones, or as a phlegmon of the bone-marrow. 
Bacteriological investigations have demonstrated that it is due 
to no specific infectious disease, but that it may be caused by 
any pus-forming organism, it may be caused, therefore, by 
many bacteria, especially in the form of mixed infection. The 
infectious irritant is most often found to be the staphylo- 
coccus pyogenes aureus (staphylomycosis of the 
bone-marrow). In other cases one of the following has been 
demonstrated as the exciting cause: staphylococcus pyogenes 
albus and citreus, streptococcus pyogenes, micrococci, colon- 
bacterium, pneumococci, and even the typhus-bacilli. The 


infectious material named has various paths of entrance to the 
blood (intestines, tonsils, lungs, skin) and develops a 


hematogenous osteomyelitis. This is usually primary, 
that is, it runs an independent course ; it may, however, occur 
as a secondary affection in connection with other infectious 
diseases. Frequently only one bone, the femur, is affected ; 
at other times several bones may be involved. On post mortem 


OSTEOMYELITIS 223 


examination the following changes are found: multiple, 
confluent pus-foci in the bone marrow, and 
even total suppurationandichorous ulceration 
of this tissue; there also occurs a suppurative periostitis, 
necrosis of the bones, bending and curvature of the bones, as 
well as pyemia and septicemia. Severe types of the disease 
present the following clinical symptoms: very high 
fever, pronounced local swelling and pain, 
as wellas severe general disease which occasionally 
leads to death in a few days (type of typhus). In 
other cases the disease presents the symptoms of an acute 
articular rheumatism. One also observes a chronic course ; 
it often occurs that healing results from early operative treat- 
ment (removal with a chisel, curettage, resection, amputation). 

PRIMARY OSTEOMYELITIS IN ANIMALS.—Are domes- 
tic animals also affected with an acute infec-, 
tious osteomyelitis? Asa result of experience with 
pyemia, foal-lameness, swine-erysipelas, and serum-inocula- 
tions, its occurrence cannot be disputed. Osteomyelitis has 
been experimentally produced in growing rabbits by intraven- 
ous injections of staphylococcus pyogenes aureus ( Lexer, 
Rodet). Spontaneous cases, however, with the excep- 
tion of twoin the horse described by myself and Karnbach 
(Monatshefte fur praktische Tierheilkunde, 1903), have not 
been recorded from reliable sources in veterinary literature. 
In both these cases staphylococci were demonstrated as 
the cause; the paths of entrance are through injuries in the 
skin, especially those resulting from gangrenous dermatitis 
(grease). At the same time a contusion occurred asa 
predisposing cause of the disease. In both horses only short, 
‘spongy bones were affected, especially the first and third 
phalanges. 

The clinical appearance of osteomyelitis consists 
of the following symptoms, which are very important from a 
diagnostic standpoint: the first symptom of osteo- 
myelitis in horses consists of a suddenly 
developing lameness in the diseased foot. 
From the very first this may be so pronounced that the animal 


224 OSTEOMYELITIS 


will be unable to bear weight on the limb; the degree of 
lameness may be very slight at first so that recovery is appar- 
ent, this being followed in a few days by a sudden and pro- 
nounced reappearance of the symptoms. If the seat of the 
disease is in the phalanges the animal holds the limb in an 
attitude of pronounced flexion. Every attempt to extend 
the toe results in severe pain. Pronounced swelling 
of the involved extremity soon follows the high-grade lame- 
ness. The swelling is relatively painless, and it 
is further characterized by the fact that it is present only 
inthe vicinity of the diseased bones. After the 
disease has existed for a long time thickening of the 
bone can be easily recognized. In osteomyelitis, especially, 
the disease process soon involves the periosteum. The peri- 
osteal osseous new-formation 1s either confined to 
the affected area, or extends over the entire length of the bones. 
This thickening, which is characterized by its hard con- 
Ssistence, may be recognized by careful palpation combined 
with pressure. Finally, after more or lesstime, pronounced 
fluctuation with abscess and fistula forma- 
tion appears on the surface of the swelling. Under certain 
circumstances incision of the abscesses, as in man, leads toa 
confirmation of the diagnosis, when the discharged pus con- 
tains free drops of fat, when a probe comes in contact with 
rough bone, or when a canal passes into the bone. The 
diagnosis in the incipient stages of the disease 
offers the greatest difficulities if no characteristic indications 
are present. In this case, the differential diagnosis 
of several diseases comes into consideration, they are easily 
confused, this is especially true of the following: inflamma- 
tions of joints, periostites, fissures and fractures, phlegmons, 
botryomycosis, etc. 

The prognosis of osteomyelitis in the horse is as 
unfavorable asin man. If the osteomyelitis, itself, ter- 
minates, the termination of the affection is relatively favorable 
through encapsulation of the focus of disease. Such an 
abscess of the bone, however, as experience has taught in 
man, may be a constant source of further pain and lameness. 


OSTEOMYELITIS 225, 


Asa result of concussions the process may become acute and. 
again assume the form of osteomyelitis. Outward pene- 
tration of the pus is another termination. It first forms 
a subperiosteal phlegmon, after the periosteum has. 
been broken down by the pus there is formed a phlegmon 
of the subcutem and muscles that surround the bone, 
this eventually results in the formation of multiple fistule. 
When the abscess is situated in the vicinity of articular surfaces: 
(as occurred in the horses described), which is the rule in man 
(embolic infarcts of the epiphyseal vessels of the articular ends 
according to Lexer), the contents may break into the joint- 
cavity and lead to suppurative inflammation of 
the joint. The prognosis of such a secondary suppurative 
arthritis is always bad in horses. Finally, pressure laminitis 
may occur in the normal foot, general pyemia may also develop. 
With reference to the treatment of osteomyelitis it should 
be remarked that from an economic standpoint the animal 
should be slaughtered as soon as the diagnosis is confirmed. 
Operative opening of the diseased bone with the hammer and 
chisel followed by curettage of the pus-foci should be experi- 
mentally employed only in very valuable horses. 


One case described by Haas as ‘‘Infectious Osteomyelitis in Cattle’» 
may possibly have been a genuine case of primary infectious osteomye- 
litis as recognized in human surgery. A Swiss cow, froma fine milk- 
type, which had not been sick for the past three years suddenly became 
ill, presenting the following symptoms: rise of temperature (40.1 C); a 
hot, painful, hard swelling on the right fore-arm beneath the elbow- 
joint on which no injury to the skin was visible. At first the case was 
diagnosed as phlegmon. After ten days of fruitless treatment, during 
which the swelling gradually enlarged, the diagnosis of phlegmon was 
discarded for that of periostitis. A few days later a softening was de- 
tected in the depths of the swelling, this was incised and a small amount 
of pus escaped through the opening ; a fistulous canal leading towards 
the radius was discovered. Improvement was rapid for a time, when 
the condition suddenly became worse, the temperature was high and 
the animal fell off rapidly in condition. There occurred burrowing of 
pus, thickening of the periosteum, the surface of the bone became 
rough, and small sloughed pieces of bone were found in the pus. A 
few days later there appeared a fluctuating swelling as broad as two 
hands at the left hip-joint, this was soon followed by a second (pyemic 
metastasis). As healing was now impossible the cow was killed. On 


226 NECROSIS OF BONE 


post mortem the following changes were noted: the bone-marrow 
was very red and contained suppurative foci as large 
asthe head of a pin. The tela ossea, also, was affected with 
suppuration and necrosis, the periosteum was swollen and loosened 
as the result of a serous exudate, it could be easily raised. The pus 
of the bone-marrow contained staphylococcus pyo- 
genes aureus and albus. 

Lucet has described an acute, infectious osteoarthritis in young 
geese ; staphylococcus pyogenes aureus was found in the pus. Suppu- 
ration of bone was produced experimentally in animals by injecting 
cultures of the coccus. 

The cases described by Frank, Osterman, Janson, Schick, 
and others under this heading remain open to question. A classification 
of the pathological changes in the boi1e-marrow in different diseases of 
the horse has been arranged by Sticker. 


III. NECROSIS, ATROPHY, AND HYPERTROPHY OF BONES. 
I. NECROSIS OF BONES. 


CausEs.—Necrosis, that is, gangrenous death of par- 
ticles of bone or entire bone, is usually the result of disturbed 
circulation in the bones (anemic necrosis). Necrosis 
may be due to traumatic influences, in which circum- 
scribed portions of the bone are splintered by wounds or com- 
plicated fractures and thus cut off from nourishment ; 
if wound infection occurs at the same time the splinters become 
necrotic, while small aseptic pieces of bone are resorbed. One 
frequently observes this form of bone necrosis in horses on the 
inferior and superior maxille (bone fistula), sternum (sternal 
fistula), on the ribs (costal fistula), and on the pelvis (pelvic fis- 
tula). In other cases the necrosis is of inflammatory 
origin; especially as a result of suppurative perios- 
titis and osteomyelitis, or it may develop in the 
vicinity of strangles abscesses, as well as by exten- 
sion of a neighboring inflammation to the bone-marrow (pus- 
bacteria, necrosis bacillus). In this #mgageen 
necrosis of the turbinated and ethmoid bones may result from 
chronic inflammation of the nasal mucous membranes ; necrotic 
pododermatitis may lead to necrosis of the os pedis; necrosis 


NECROSIS OF BONE 227 


of the tendon, to necrosis of the navicular bone ; phlegmon of 
the neck, withers, or tail, to necrosis of the cervical vertebrez, 
the dorsal spines, or the coccygeal vertebre. Necrosis of the 
cartilage occurs in a similar manner (fistula of the lateral car- 
tilage.) Bone-caries is a special form of necrosis of the 
bones. Itis usually the result of a granular, tubercular ostitis 
and osteomyelitis, which leads to the death of portions of the 
bone, and to lacunar liquefaction and progressive softening, 
with partial resorption of the necrotie portions (Cf: Tubercu- 
losis of the Bones, page 171). When pieces of bone are 
sloughed off during the course of cariesitistermed necrotic 
caries. A similar form of caries affects the teeth, especially 
the molar teeth of horses, so-called tooth-caries. This 
consists in a progressive degeneration of the cement and the 
dentine-substance caused by the decomposition of masses of 
food, and the entrance of bacteria through spaces in the enamel 
(rasping!) into the substance of the tooth. Embolic 
necrosis is very rare in the domestic animals (primary embolic 
necrosis of the first and third phalanges, see page 223; embolic 
necrosis of the sphenoid bone in contagious pleuro- pneumonia). 
Phosphorus necrosis of the maxillary bones as 
seen in man, has been observed only in experimental ani- 
mals (rabbits) after the inhalation of fumes from phosphorus. 

Forms.—One recognizes a partial (circumscribed) 
and total (diffuse), a simple and multiple, as well 
asa superficial and deep necrosis. 

The latter classification is of special practical importance. 

a) Deep necrosis is usually circumscribed. The 
necrosed piece of bone is termed a sequester, the pro- 
cess of sloughing is termed sequestration. The 
sequester is separated from the sound bone by ademarking 
ostitis, its surface becomes corroded and liquefied as a 
result of lacunar bone resorption (osteoporosis, ero- 
sion) at the same time there develops a wall of newly- 
formed osseous tissue around the line of demarcation in the 
form of a bone-capsule (bony case, dead covering). From 
the bony covering a canal frequently leads to the surface 
(bone-fistula), the sequester frequently passes through 


228 ATROPHY OF BONE 


the canal and is cast off. Occasionally the entire bone is 
thickened during the process of sequestration. Total necrosis 
of a large bone is very rare—for example, the scapula of a 
horse (necrosis formation extending from the periosteum ). 

b) Superficial bone-necrosis is frequently characterized 
by exfoliation. 

TREATMENT.—AsS in treatment of other organs, treatment 
of bone-necrosis is purely operative. It consists in removal of 
the necrotic portion—the bone-sequester, which sustains the 
bone fistula, by means of curettage, the bone-chisel, and 
trephine, and the removal of the sequester with bone-forceps 
(sequestrotomy, necrotomy). The injection of 
caustics, as well as cauterization of the fistulous tract, seldom 
results in healing. 


2. ATROPHY OF BONE; 


ForMs.—One recognizes a concentric atrophy, that 
is, one extending from without inwards, which is also termed 
erosion atrophy of the bone; and an excentric, one which 
proceeds from within outwards (osteoporosis). A classi- 
fication according to causes is more important. According to 
the latter classification the following forms are recognized : 

a) Inflammatory atrophy or osteoporosis 
occurs during the course of a rarefying ostitis (initial stages of 
spavin, actinomycosis, osteomalacia, leukemia). 

b) Pressure atrophy or erosion occurs on the os 
pedis through pressure from the horny sole ; on the navicular 
bone during podotrochlitis; on the vertebral column as the 
result of an aortal aneurysm; on the nasal bones through 
tumors within or external to the nasal cavities; on the maxil- 
lary and frontal bones through new-formations in the maxil- 
lary and frontal sinuses ; ccenurus cerebralis may cause atrophy 
of the bones of the skull. 

c) Atrophy of inactivity occurs with muscular 
atrophy in chronic forms of lameness (spavin, ringbone), 
especially on the tarsus, metatarsus, and metacarpus. 


RACHITIS AND OSTEOMALACIA 229 


d) Senile atrophy may lead to fracture of the vertebrz 
during the act of casting old animals. 

e) Neurotic atrophy during the course of diseases of 
the nerves (neuroparalysis), and subsequent to incisions of 
the nerves. 


3. HYPERTROPHY OF BONE. 


FormMSs.—One recognizes a circumscribed (exosto- 
ses, osteophytes), anda diffuse hypertrophy of the bones 
(hyperostosis). There is also a form of hypertrophy that 
occurs within the bone itself, this is termed osteoschlero- 
Sis or eburnation. All these three forms are of inflam- 
matory origin. In contrast to these there has been observed a 
congenital hypertrophy of bone, which is especially seen 
in horses and dogs on the bones of the skull and face (leon- 
tiasis ossea, big-head). Congenital hypertrophy of 
different extremities, the toes for example, is termed mac- 
rodactylia; congenital hypertrophy of bone, with a simul- 
taneous hypertrophy of the soft parts, is termed acromega- 
lia; acromicria is an opposite condition. 


APPENDAGH. RACHITIS AND OSTEOMALACIA. 


DEFINITION.—The nature of rachitis and osteomalacia as well as 
the relation of both to each other has not yet been determined in a 
manner entirely satisfactory and consistent. Ordinarily rachitis is de- 
fined as a bone-disease which affects young, still developing 
bones; asa result of the disease they do not ossify, but continue in a 
form of cartilaginous development. In contrast to this, osteomalacia 
or bone-fragility, is a disease of old, developed bones which is 
characterized by the loss of bone salts (halisteresis). The following 
are classified among the causes of both diseases: specific infectious 
inflammations of bone (epizootic development, inflammation 
of bone similar to that caused by phosphorus poisoning) ; deficiency 
of lime in the food (experimental development of rachitis in young 
animals as a result of living on food deficient in lime salts, rachitis in 
pigs and dogs kept on an exclusive diet of potatoes and bread, osteoma- 
lacia in anemic milch cows whose diet is poorin lime). For further 
information see Friedberger and Frohner: ‘‘Special Pathology 
and Therapeutics.’’ 1904, Sixth Ed. Vol. I. 


230 RACHITIS 


RACHITIS.—Rachitis (softening of the bone) most frequently occurs 
in young pigs and puppies, as well as in birds. It is seldom seen in 
foals andcalves. According to Kassowitz rachitis is characterized 
anatomically by a pathological vascularization of the 
bone-forming tissue in the form of a chronic hyperemia and 
inflammation at the seat of apposition (epiphyses, periosteum, and 
bone marrow). This results in the following changes: 

I. Proliferation of the cartilage at the epiphyses. 

2. Lacunar liquefaction (halisteresis) of the formed bone. 

3. Irregular deposits of lime in the: developing 
bone. 

In general the anatomical changes in the bone are as follows: the 
periosteum is hyperemic and presents, on the inner side, a pro- 
nounced proliferation and thickening of the bone-forming layers, 
whereby the newly developed tissue is not ossified, but, for the 
most part, remains soft. Ossification of this tissue occurs later, this 
gives the bone a thick, plump appearance, a circumscribed enlargement 
is recognized. The periosteal proliferations are most often seen at the 
muscular attachments ; in swine at the femoral attachment of the psoas. 
magnus and internal iliacus, very often at the tuberosity of the calcan- 
eum ; in certain cases the thickened periosteum may be torn away from 
bones by muscular contraction, in swine from the scapula. The principal 
changes in rachitic bones occur at the boundaries of the epiphyses and 
consist in an abnormal proliferation of the epiphyseal 
cartilage without sufficient calcification. Normally the cartilage 
between the epiphyses and diaphyses is composed of two, thin, paral- 
lel layers ; the proliferating and the ossifying layer. In rachitic bones. 
the proliferating layer is overdeveloped, while the ossifying layer is. 
abnormally small; instead of being parallel they are now irregular. 
This abnormal proliferation of the epiphyseal cartilage leads toa thick- 
ening and swelling of the epiphysis which ossifies only 
when the disease has run a long course; it leadstoa curving and 
bending of the long bones, and finally toa dislocation of the 
epiphyses. whereby the attachment between the epiphyses and 
diapyses becomes loosened. 

The most important symptoms of rachitis consist in a swelling 
and enlargement of the epiphyses of the bones in the vicinity of the 
joints (double-jointed); ina bending and curvature of the bones. 
of the extremities (shaped like the limbs of a badger 
hound, or like a sabre); the vertebral column is curved down- 
wards (lordosis), upwards (kyphosis), or laterally (scoliosis). 
Swellings occur at the articulations of the ribs and costal cartilages. 
(rachitic beads); the pelvis becomes deformed (rachitic 
pelvis); the coronary joint presents exostosis formation (rachitic 
ringbonme ); asymmetry occurs in the formation of the skull; forma- 
tion of a so-called chicken-breast, etc. 


OSTEOMALACIA g3% 


Treatment of rachitis consists, in addition to the removal of the 
cause (change of food), in the administration of phosphorus; for 
the horse, one to five centigrams; dog, one half to two milligrams. 
They should receive a diet of bone-meal. 

OSTEOMALACIA.—Osteomalacia, or bone-fragility, is most often 
seen in milch cows, especially during the period of lactation or preg- 
nancy ; it is occasionally seen in horses (bran-disease, osteoporosis). 
Opinions concerning the nature of the disease are extremely variable. 

I. Virehow and others considerit a chronic, parenchy- 
matous inflammation of the bone or a rachitis of 
adults. Asa result of accelerated vascular proliferations there results, 
on the one side, a new-formation of soft, osteoid masses; on the other, 
a lacunar resorption (halisteresis). 

2. Ziegler considers it a pure halisteresis—that is, a 
simple decalcification of the bones without inflammatory new- 
formation. 

3. Peptrone has defined bone-fragility as an infectious 
disease due toa specific bacterium (nitrification). 

The anatomical changes in the bones, which are especially promi- 
nent in those of the trunk and upper limbs, are as follows: in the early 
stages of the disease and in light attacks, if one examines carefully, 
an increased blood-supply is visible in the diseased bones. 
There is a dilitation of the vessels and the canals through which they 
pass. A section of the bone brings into sight small hemorrhagic points, 
the marrow is infiltrated with many small extravasates, the bone tissue 
in the vicinity of the dilated Haversian canals presents slight changes. 
Ina more severe type the hyperemia is pronounced ; the external 
surface of the matrix, as wellasa cut surface of the bone, present 
highly colored points, the marrow is very hyperemic and filled 
with hemorrhagic areas. The marrow cavities are dilated. 
In the diploe and on the inner surface of the matrix one finds many 
small pieces of bone that have become loosened from the surrounding 
tissue. The bones are easier to saw or cut, their tone is 
not so clear. Microscopically the homogeneous structure of the bone 
substance is atrophied ; in certain areas it appears more transparent, the 
bone-corpuscles are enlarged and transparent, in form they become 
oval, round, and even polyhedral, their processes disappear. The 
bone-cells gradually undergo fatty degeneration. 
The entire process is atransformation of certain areas 
of the bone-substance into osteoid, and finally into 
marrow tissue. In the most severe types of osteomalacia 
the hyperemia of the bone and marrow is still more pronounced, the 
osseous substance becomes spongy, more friable, 
and softer; the matrix and diploe become smaller and smaller; the 
marrow gradually increases. The matrix is displaced from within 


232 DISEASES OF JOINTS 


outwards, and is removed, even at the epiphyses; fr actures of the 
bone occur. When there exists a general derangement of the nutrition, 
the marrow itself becomes softened, gelatinous, even watery, and pre- 
sents a dirty-yellow color. The specific gravity of the bone 
diminishes until more than half of the lime salts have disappeared ; 
it contains, however, more water. 

The symptoms of osteomalacia in- cattle are as follows: severe 
derangement of the nourishment, emaciation, weak digestion, symptoms 
of opsomania, hardening of the skin, cachexia, lameness, bone - 
fractures, infractions, and distorsions. Fractures of the 
pelvis and ribs are especially frequent, they often result from the slight- 
est provocation (rising, lying, twisting, parturition), and are often 
multiple. 3 

Treatment consists in a change of food (food containing lime), 
administration of bone-meal or phosphates of lime, as wellas, above all, 
inthe internal abministration of phosphorus (1-5 centigrams per 
cow) in oil. Ovariotomy (castration) has been followed by good results 
in man, it may be experimentally employed in cattle. 


DISEASES OF JOIN Is: 


ANATOMICAL CONSIDERATIONS.—From a surgical standpoint the 
synovial structures (joint-capsule, synovial membrane) are the 
most important anatomical portions of the joint. In comparison with the 
capsular ligament, the other ligaments of the joint, especially the lateral 
ligaments, anterior and posterior ligaments, etc., are of secondary 
importance from a surgical standpoint. By most authors the. 
synovial membrane is considered a serous structure 
which has its analogue in the peritoneum and the pleura. Its inner 
surface is covered with asimple endothelial layer which covers 
the processes—the diverticuli and villi of the synovial membrane—but 
does not cover the cartilage. Only in the fetus, as well as after a long 
period of rest forthe joint, does the synovial endothelium partially 
cover the cartilage. The external layer of the synovial membrane, 
which serves as its basis, is composed of a net-work of connective. 
tissue and elastic fibers. (Others consider the synovialis, not a serous, 
but a fibrous membrane). 


The villi of the joint form fine, hair-like proliferations 
directed from the synovial membrane towards the cavity of the joint, 
occasionally daughter-villi are present. According to their histological 
characteristics they are classified as follows: mucous villi, fat- 
villi, cartilaginous villi, and%ibrous villi, between these 
there frequently occur transitional formg. According to Tillmanns 
the synovia is formed principally from the mucous and fat-villi, 
partly through secretions, partly through a solution of their cellular 


ARTHRITIS 233 


elements. Schneidemiuhl, onthe other hand, supports the theory 
that Tillmanns’ classification depends ona pathological condition, and 
that the synovia is not formed by acontinual disintegration of the 
endothelial cells, but, as in other serous cavities from an independent 
secretion. The secretory activity forms, therefore, the 
Petucipaliunction of the endothelium of the joint. 
The villi of the synovial membrane and joint are extremely rich in 
vessels especially in lymph-vessels, which apparently communi- 
cate directly with the joint-cavity through open stomata; this explains 
the great resorptive ability of the joint-capsule. The hyaline 
cartilage, which covers both ends of the bones, is only apparently 
homogeneous, normally it is composed of small fibers, this explains the 
fibrillation found in various pathological conditions (Tillmanns). 


I. INFLAMMATION OF JOINTS. ARTHRITIS OR SYNOVITIS: 


CLASSIFICATION.—According to the causes, ana- 
tomical characteristics, and course, inflammation of the 
joints (synovitis) may receive various classifications. 

From an etiological standpoint, .one distinguishes, 
above all, a non-infectious (aseptic), and infec- 
tious (septic) inflammation of the joint. Traumatic 
arthritis is the most common, that is, an arthritis due to 
injury, it may be aseptic or septic. There is also recognized 
a primary and secondary inflammation of joints. The primary 
develops direct, at the seat of action of the inflammatory irri- 
tant. The secondary develops through extension from a 
neighboring inflammatory process ; for example, inflammation 
of the joint extending fromthe bone, or hematogenous 
through the medium of the blood. Hematogenous arthritis 
has been termed symptomatic or metastatic. It 
occurs during the course of infectious diseases (acute articular 
rheumatism, pyemia, septicemia, contagious pleuropneumonia, 
infectious abortion, foal-lameness, petechial fever, malignant 
head-catarrh in cattle, strangles, swine-erysipelas, swine- 
plague, dog-distemper, glanders, tuberculosis, intravenous 
injections of streptococci, etc., and in serum horses), it is 
occasionally seen in cattle as the result of abortion, retention 
of the fetal membranes, and metritis (puerperal pyemia), as 
well as in lameness in calves (polyarthritis ) ; in goats during 


234 SEROUS ARTHRITIS 


the course of an infectious agalactia; finally, as the result of 
certain constitutional diseases (gout). When several joints 
are diseased at the same time it is termed polyarthritis 
(rheumatic, septic, uric, pyemic), in contrast to traumatic 
monarthritis. Symptomatic inflammations of the joints. 
include the specific forms of arthritis (tuberculosis, glan- 
ders, actinomycosis).—In cattle, even certain physiological 
forms of arthritis are observed, those occurring with change 
of teeth and development of bone ‘‘dentition arthritis’’ (?). 
According to the course, arthritis is classified as acute and 
chronic. 

According to the anatomical character of the in- 
flammation, one distinguishes an exudative and a dry 
inflammation of the joint (arthritis sicca). According to the 
character of the exudate and the product of the inflammation 
one further distinguishes the following forms: serous, sero- 
fibrinous, fibrinous, suppurative, hemorre 
hagic, ichorous, deforming, case€ous, Cages 
hal, pannous, fungoid, granular,) €1Oqne 
and ulcerative arthritis. 

In the domestic animals the following are the most im- 
portant and most frequent forms of arthritis, because of their 
practical importance they are fully described : 

1. Serous arthritis. 

2. Suppurative arthritis. 

20) (CLOT uine arthritic: 

4. Tubercular arthritis. 


I. SEROUS INFLAMMATION OF JOINTS. ARTHRITIS SEROSA. 


CAuUSES.—Serous arthritis is most frequently observed 
in dogs and horses asa traumatic, aseptic inflamma- 
tion resulting from contusions and distorsions. It may occur, 
however, asa symptomatic arthritis, especially in acute 
articular rheumatism (polyarthritis serosa), less frequently in. 
pleuropneumonia, as wellas metastatically in cattleasa 
result of retention of the afterbirth ; it may also occur during 
the course of mastitis (hip-joint, knee-joint, tarsal-joint). 


SEROUS ARTHRITIS 235, 


SYMPTOMS.—Serous inflammation of the joints occurs in 
two forms: acute and chronic. 

a) Acute, serous arthritis is usually a traumatic 
inflammation of the tarsal-joint, fetlock-joint, knee-joint, car- 
pal-joint, or hip-joint, without injury to the joint-capsule. 
It develops suddenly and presents the following symptoms: 
Reeeircumscribed and fluctuating swelling, 
intense pain, lameness, and increased tem-* 
perature of the involved joint, thereis not usually a 
“general rise of temperature. High fever is present. 
only in symptomatic arthritis. Acute serous arthritis termi- 
nates in resorption of the fluid exudate followed by healing, 
or, if resorption fails, it passes into the chronic form. In the 
latter case the prognosis is unfavorable. | 

b) Chronic serous arthritis, also termed 
chronic hydrops or joint-gall, develops from the 
acute form, or it may be progressively chronic in nature, In 
the latter case it is often supported by a hereditary predisposi- 
tion in the form of an atony or slight vulnerability of the joint. 
In contrast to acute arthritis, the swelling of a chronic hydrops. 
is painless andretainsa normal temperature; inter- 
ference with movement is absent or slight. Occasionally this 
form is intermittent in character. It is especially common in 
horses and cattle in the form of so-called galls or the fetlock-, 
tarsal-, or knee-joints. ; 

TREATMENT.-—Acute serous arthritis in the early stages 
is treated as follows: rest, moist heat, Pri esnitz com- 
press, compression, plaster-of-Paris bandage, and massage ; in 
the latter stages, with irritating applications (tincture of iodine, 
cantharides-collodion). The often incurable, chronic serous 
arthritis may be treated with blisters and firing.. The method 
of treatment successfully employed in human surgery, where 
tue, 7Oint is punctured in an aseptic manner 
and followed by antiseptic irrigation, is not indi- 
cated in the treatment of the horse where a bandage can be 
applied only with difficulty or not at all. In the treatment of 
dogs this method may be experimentally employed. From a 
prophylactic standpoint horses with joint-galls may be excluded 
for breeding purposes. 


236 SUPPURATIVE ARTHRITIS 
2. SUPPURATIVE INFLAMMATION OF JOINTS, ARTHRITIS 
PURULENTA. 


CausEs.—Suppurative or pyo-ichorous arthritis is due to 
the entrance of pus-forming bacteria into the joint. 


Asarule they gain entrance through perforating joint- . 


wounds. In other cases a suppurative inflamma- 
tion in the vicinity extends to the joint (subcoronary 
phlegmon, suppurative podotrochlitis and pododermatitis, 
phlegmon of the fatty frog to the pedal-joint). Pus-bacteria 
may also gain entrance to the joint through a hematogenic 
course; this is the most often seen during the course of a 
pyemic polyarthritis in foals and calves. In horses, the 
severe, acute suppurative arthritis which usually terminates 
in septicemia is most often caused by staphylococcus pyo- 


genes aureus; the subacute type, by streptococcus pyogenes . 


(Bosi). Staphylococcus pyogenes aureus (Sohnle) and 
streptococcus pyogenes (Ostertag) have also been found 
in suppurative and sero- purulent polyarthritis of foal-lameness. 
In polyarthritis of calves, on the other hand, the colon bacillus 
seems to play the principal part (Zschokke). 
PATHOLOGICAL CONDITION.—In a suppurative and ichor- 
ous arthritis one finds greyish-yellow or light-yellow, cream- 
like, and viscid contents in the joint (suppurative arthritis) ; 
or an ichorous, discolored, brownish, chocolate-colored, grey- 
ish-brown, or dirty-green fluid, which is fetid and filled with 
bubbles of gas (ichorous arthritis). The synovial membrane 
is swollen, highly reddened, markedly thickened (as much as 
one-half centimeter), and similar to an abscess-wall ; the inner 
surface is covered with villiform, soft, reddish-grey granula- 
tions. The slightest changes appear to be in the articular 
cartilage. Marked erosions and ulcerous defects 
are usually absent; occasionally the cartilage is somewhat 
rough and cloudy (glistening is absent), in many places it is 
more or less thinned and softened. Abnormal color is the 
most pronounced characteristic (light-grey, greyish-blue, 
greyish-green, bluish-white). Inthe ends of the bones, 


SUPPURATIVE ARTHRITIS 237 


when the process has existed for a long time, one finds osteo- 
myelitic processes, inflammmatory osteoporosis and necrosis. 

The general anatomical changes are usually of a 
septicemic nature (inflammatory swelling of the liver, 
spleen, pancreas, heart, gastric glands, edema of the lungs 
and glottis, hemorrhagic laryngitis and pharyngitis). Pyemic 
changes are less frequent ; thisis also true of genuine metas- 
tases, especially in the lungs in the form of a multiple, 
focus-like gangrenous pneumonia _ (necrosis 
bacillus). 

SYMPTOMS.—Suppurative. arthritis (empyema of the 
joint), in contrast to serous inflammations of the joint, is char- 
acterized by fever, symptoms of severe general 
disturbance and severe lameness, as well as 
feerreciimseribed, diffuse, circular, hot and 
painful swelling of the joint (parasynovial phlegmon 
and suppuration ), occasionally periarticular abscesses are pres- 
ent. If this condition is accompanied by a penetrating joint- 
wound a suppurative discharge flows from the joint 
into which one may pass a finger or probe. In the horse 
the suppurative and pyo-ichorous forms of 
arthrites of the large joints, seem, asarule, 
Memeo tanpidivreratalcourse as the result of 
septicemia or septicopyemia. In suppurative 
inflammation of the small joints, especially the hoof-joint, the 
fatal termination is somewhat delayed (one or two weeks). 
Suppurative inflammation of the small joints in the horse is 
occasionally followed by healing andanchylosis forma- 
tion. This is especially true of the lower rows of the tarsal- 
joints (intertarsal joints, tarso-metatarsal joints) when the 
point cautery has been used for the treatment of spavin, of 
the lower rows of the carpal-joints, of the fetlock-joint, and the 
pedal-joint. It is a peculiar fact that the ass and mule, in 
comparison with the horse, are less severely affected with sup- 
purative arthritis (Bosi). One occasionally observes a 
chronic form in cattle, this is especially true of the hip-joint. 

TREATMENT. —The following forms are usually ineur- 
able in the horse: purulent and pyo-ichorous arthritis of 


238 DEFORMING ARTHRITIS 


the hip-, knee-, tarsal-, shoulder-, elbow-, coronary-, and 
pedal-joints. In all these cases, therefore, from an economic 
standpoint, it is usually best to advise early slaughter. Occa- 
sionally they can be treated, as in human surgery, with 
puncture and incision, antiseptic cleameuags 
drainage, and permanent irrigation of the sup- 
purating joint. I have observed healing in the horse in four 
cases of suppurative arthritis of the fetlock-joint, as well as in 
many cases of suppurative arthritis of the pedal-joint (perfo- 
rating nail punctures, resection of the perforans tendon). 
IL.utz has also described a case of healing. ‘Treatment for 
the dog, on the other hand, is more often indicated as bandag- 
ing is more easily employed ; in certain cases, one may resort 
to resection of the joint and amputation. In two 
cases I have resected a suppurative maxillary-joint in the 
horse with good results. 


3. DEFORMING INLAMMATION OF JOINTS. ARTHRITIS. 


DEFORMANS. 


DEFINITION.—In human medicine ‘‘deforming’’ 
inflammation of the joint indicates a chronic, aseptic, 
senile arthritis (malum senile), which leads to per- 
manent and severe changés. in the vem 
joint; it is not combined with suppuration. Its occurrence 
may be spontaneous or traumatic ; it may be either mono- or 
polyarticular; its favorite seat is in the hip-, knee-, 
shoulder-, and elbow-joints, and in the fingers and vertebral 
column; ordinarily it continues during life, is non-febrile, is 
ushered in with stiffness, crepitation, and slight sensitiveness 
in the involved joints; finally, it leads to deformity of the 
entire joint. Anatomically it is characterized by de- 
generative as well as newly formed processes 
inthe cartilage, bones, and joint-capsule. 

a) Inthe articular cartilage one finds, on the 
one side, changes which are typical of a chronic, ulcera- 
tive, dry arthritis; namely, fibrillation of the super-— 
ficial layers, foci of disruption and softening in the deeper lay- 


DEFORMING ARTHRITIS 239 


ers, erosion and even complete atrophy of the cartilage with 
the formation of smooth, polished surfaces ; on the other side, 
there occur active proliferations of the cartilage in the form of 
nodular swellings. 

b) Inthe bones there exists a subchondral inflam- 
matoryosteoporosis with lacunar atrophy of the bone, 
in addition to bony new-formations. 

c) The joint-capsule shows proliferation, 
thickening, and shriveling, one also occasionally 
observes the formation of free joint-bodies. 

These combined changes result in pronounced deformities 
in the involved joints, whereby their mobility is either re- 
stricted or entirely suspended, or it may result in an excessive 
mobility of the joints (luxations, loose joints). 

OCCURRENCE IN ANIMALS.—The following diseases may 
be classified under chronic deforming inflammation of the joint : 
Spavin and articular ringbone in the horse; certain 
forms of gonitis that are characterized by severe swelling 
of the joint; omarthritis (inflammation of the shoulder- 
joint); and coxitis (inflammation of the hip-joint) in dogs, 
horses, and cattle. Chronic, deforming inflammatory pro- 
cesses are also frequent in the pedal-joint (so-called ringbone 
of the pedal-joint), and in the carpal-joint (so called spavin of 
the carpus) of the horse. So-called chronic lameness 
of the pedal-joint (bursitis podotrochlearis) and sesa- 
moid lameness inthe horse, show a certain analogy to 
arthritis. One also observes deforming arthritic changes in 
chronic articular rheumatism. Sticker described 
a case of polyarthritis deformans in the horse which showed 
cauliflower-like, cartilaginous and osseous growths around the 
margins of the joints, thickening and villous proliferations on 
the synovial membrane, as well as an increase in the amount 
of synovia. 

The relation of spavin and ringbone, as wellas- 
chronic gonitis and omarthritis in the horse, to de- 
forming arthritis, is of specia] importance. 

1. Inthe text-books on surgery SPAVIN is usually defined 
asachronic deforming arthritis tarsi. In this 


240 DEFORMING ARTHRITIS 


form the term is not entirely correct. According tothe excel- 
lent investigations of Gotti, whose accuracy has been 
proved by Bayer, Eberlein, and myself, spavin, in 
many cases, is not a primary disease of the cartilage; the 
bone forms the primary seat of the disease. Spavin is 
primarily an ostitis of the cuneiform magnum 
and medium, as well as the metatarsus; de- 
forming inflammation of the tarsal-jointisa 
secondary disease which develops from the 
ostitis. “Osteoarthritis chronica deformans’’, 
therefore, is a more accurate term for spavin. According to 
Gotti spavin is a slowly developing inflammatory process in 
the bones, it is characterized by decalcification (inflamma- 
tory osteoporosis, rarefying ostitis) whereby 
numerous small or large spaces become visible in the bone; in 
these spaces one finds soft, reddish masses which resemble 
granulation-tissue. This rarefying ostitis may be replaced by 
a condensing ostitis (osteoschlerosis). In 
many cases, especially in the initial stages, these pathological 
changes in the bone (rarefying and condensing ostitis) are 
the only ones present in spavin, the cartilage and periosteum. 
are intact. Later in the course the ostitis may either extend 
in a central direction towards the joint, involving the articu- 
lar cartilage; or it may take a peripheral direction, that 
is, extend tothe periosteum (both processes frequently 
occur at the same time). In the first case there exists a 
secondary disease of the articular cartilage with degenera- 
tion of the cartilage, active proliferation of the carti- — 
laginous cells, and the formation ofan inner anchylosis. 
If the inflammatory process extends from the bone-substance 
to the periosteum it leads toan ossifying periostitis 
with the formation of osteophytes and an ex- 
ternal anchylosis. The bones of the tarsal-joint have 
then become partly osteoporotic, partly schlerotic masses 
of osseous tissue. It is very rare that the inflammation 
extends to the bursa of the tibialis anticus (compare with 
Eberlein, ‘‘Der Spat der Pferde.’’ Monatshefte fur praktische 
Tierheilkunde. 1898). 


DEFORMING ARTHRITIS 241 


2. RINGBONE is a collective term for various chronic, 
aseptic inflammatory processes at the coronary-joint. 
One must differentiate, above all, between articular and 
periarticular ringbone. In periarticular ringbone the 
joint itself is not involved, it consists of a periarthritis, that 
is, a chronic ossifying periostitis at the attachments of the 
lateral ligaments or the capsular ligament (lateral, bilateral, 
circular ringbone). Articular ringbone, on the other 
hand, similar to spavin, isan osteoarthritis chronica 
deformans of the coronary-joint originating from 
an inflammatory osteoporosis of the subchondral 
bone of the first and second phalanges. There is an exten- 
sion of the primary inflammatory process in the subchondral 
portions of these bones, which leads to a secondary degen- 
merlot Of the articular cartilage, to an ero- 
sion of the cartilage, and finally to the formation of an ‘an- 
chylosis. ‘This process is accompanied by a regenerative 
process in the bones (ostitis condensans). If the subchondral 
osseous inflammation extends in a centrifugal direction—in the 
direction of the periosteum—there further occurs an ossifying 
periostitis with the formation of osteophytes in the vicinity of 
the joint, that is, in addition to the articular, there is also a 
periarticular ringbone. As arule, old cases of ring- 
bone are a complication of the’articular with 
the periarticular form. This also results in the de- 
velopment of an external anchylosis. Microscopic- 
ally the first changes in the diseased bone consist of a dilita- 
tion of the Haversian canals, lacunar formation, the formation 
of red granulation-tissue, as well as atrophy of the bone-cells, 
(Cf: Udriski, “‘Die Krongelenkschale des Pferdes.”’ 
Monatshefte ftir Praktische Tierheilkunde. 1900). 

The same changes are found in the fetlock-joint (ring- 
bone of the fetlock-joint), and pedal-joint (ring- 
fomemot the pedal-joint). (Cf: Karnbach, 
“Die Hufgelenkschale des Pferdes.’’ Monatshefte fur prak- 
tische Tierheilkunde. 1900). 

3. Chronic GoNITIS of the horse, likewise, is usually an 
osteoarthritis, sldoma pure arthritis chronica 


242 DEFORMING ARTHRITIS 


deformans. It usually attacks the medial portion of the 
knee-joint, and in most cases has its origin in the bones 
(tibia, femur) in the form of a primary rarefying ostitis. 
The inflammatory osteoporosis then extends in a central direc- 
tion to the articular cartilage (erosion of the cartilage), 
in a horizontal direction to the periosteum of the bones 
on the sides of the tibia and the femur (formation of 
osteophytes), and finally to the joint-capsule (prolifer- 
ation of the articular villi, hydrarthrostempges 
joint-bodies). Chronic gonitis in the horse less frequently 
begins in the form of a primary chondritis (proliferation of the 
cartilage-cells, fibrillation and degeneration of the intercellular 
matrix), involving the bone in the form of a secondary pro- 
cess. (Cf: Zalewsky, ‘‘Die Gonitis chronica deformans des 
Pferdes.’’ Monatschrift fir praktische Tierheilkunde. 1gor). 

4. Chronic OMARTHRITIS in the horse is the most impor- 
tant cause of so-called chronic shoulder lameness. Its seat of 
origin is also usually found in the subchondral osseous tissue 
(medial half of the joint, marginal portion of the scapula) in 
the form of an inflammatory osteoporosis with a 
subsequent osteoschlerosis. Asa result of extension to 
the articular cartilage there exists a chondritis with incur- 
ablecartilaginous erosion; nodular, warty,or crest-like 
exostoses formatthe margins of the joint, occasionally 
these lead to a subsequent anchylosis formation; 
inner anchylosis, similar to spavin and ringbone, does not 
appear to occur. The joint-capsule is thickened, the 
articular villi are enlarged ; occasionally it also leads to the 
formation of free joint-bodies. (Cf: Karnbach, Die 
Omarthritis chronica deformans des Pferdes. Monatshefte fur 
praktische Tierheilkunde. 1903). 

The treatment of chronic deforming arthritis consists 
in allowing the natural process of healing to run its course 
(condensing ostitis), or in artificial adhesion (anchylosis) of 
the joint by means of rest, firing, or blisters. Neu- 
rotomy remains as a last resort. 


TUBERCULAR ARTHRITIS 243 


4. TUBERCULAR INFLAMMATION OF JOINTS. ARTHRITIS 


GRANULOSA. 


OcCURRENCE.—In cattle, swine, and birds, occasionally 
in dogs, there occurs a tubercular arthritis, as in 
man, during the course of tuberculosis. According to the 
anatomical characteristics itistermed granular, fungoid, 
spongy, and caseous arthritis, or caries of the joint ; 
(tumor albus and fungus belong to older classifications). In 
cattle it is found in the knee-joints, hip-, elbow-, and carpal- 
joints ; in swine in the carpus and tarsus; in birds in the joints 
of the feet and wings; one case has also been observed in the 
knee-joint of the dog (Cadiot). 

ANATOMICAL CHANGES.—Tubercular arthritis is charac- 
terized by a granular inflammation with tubercular prolif- 
erations on the synovial membranes, cartilage, and bone ; 
when continued for a long time there occurs a tubercular soft- 
ening and liquefaction of the ends of the joints (caries), as 
wellas caseation; occasionally the changes are typical of 
a deforming arthritis. Tubercle-bacilli are present in the 
proliferations and in the pathological synovia. 

According to Guillebeau two forms of tubercular 
arthritis exist in cattle. Ordinarily the distended joint-capsule 
contains fibrin, the synovial papillae are enlarged, sometimes 
to the size of a hazelnut or plum ; many times they are flat, 
several centimeters in length and breadth, and of the nature 
of a pannous membrane. In the vicinity of the proliferations 
the articular cartilage is destroyed (ulcer-like defects); the 
articular epiphyseal ends of the bones are also eroded with the 
tubercular granulation tissue. Edema exists in the vicinity 
of the joint. Caseated tubercular nodules are less frequently 
observed in the synovial membranes and at the ends of the 
bones. One occasionally observes processes of healing (de- 
crease in the fibrinous exudate and the hyperplastic membrane, 
formation of a cartilaginous cicatrix). 

Symptoms.—According to Hess tubercular arthritis oc- 
curs in cattle several weeks after parturition, as well as after 
an abortion. Its favorite seat is in the knee-joint (communi- 


244 ARTICULAR RHEUMATISM 


cation with the tendon-sheath of the long extensor of the toe) 
and in the elbow-joint. The disease frequently begins with a 
severe lameness and in most cases runs a chronic course. As 
arule it is incurableand is associated with pronounced 
muscular atrophy. . The diagnosis can be confirmed by 
means of a tuberculin injection. 


ARTHRITIS FIBRINOSA.—Fibrinous or croupous inflammation of the 
joint is characterized by aserous exudate rich in fibrin, for this reason 
itis also termed a sero-fibrinous arthritis. On palpation the 
fibrin is recognized by a fine, crepitating sound (arthritis crepi- 
tans). By many, fibrinous inflammation of the joint istermed catarr- 
hal arthritis (increased desquamation of the mucous villi), and is con- 
sidered a mild type of suppurative arthritis(Volkmann). It frequently 
leads to anchylosis, occasionally to the formation of joint-bodies. Itis 
found in tubercular arthritis of cattle (see above). 

ARTHRITIS PANNOSA.—Pannous inflammation of the joints 
(arthritis chronica proliferans, or arthritis hyper- 
plastica laevis) isa chronic arthritis characterized by the presence 
of newly formed vascular granulation-tissue on the 
surfaces of the articular cartilage. It is seen in chronic 
hydrops, during the course of a chronic articular rheumatism, and in 

tubercular arthritis of cattle (see above). Occasionally it leads to the 
formation of free joint-bodies (corpora libera), as well as toa fibrous 
anchylosis. 

ARTHRITIS CHRONICA Sicca.—Dry or ulcerative inflammation of 
the joint (arthritis chronica ulcerosa) is observed in the horse 
after a chronie lameness as the result of a long period of rest for the 
joint ; itis seen after a severe distorsion, as well as in the early stages of 
a deforming arthritis. It is characterized by fibrillation, disin- 
tegration and erosion of the articular cartilage. Horses 
and dogs are most frequently affected. 

ARTICULAR RHEUMATISM.—This is a febrile, infectious dis- 
ease accompanied by a serous polyarthritis; it occurs 
most frequently in cattle, less frequently in goats, swine, dogs, and 
horses. Usually several joints are suddenly affected with a very pain- 
ful serous arthritis ; its favorite location is in the carpal-, tarsal-, and 
knee-joints ; it results in severe lameness. In cattle, especially, rheum- 
atism of the joints is accompanied with inflammation of the tendon- 
sheaths. As in man, the development of endocarditis (valvular disease) 
forms an important complication. Though usually beginning as an 
acute or peracute disease, it ordinarily runs a chronic course. The 
anatomical changes in the joinits consist largely of a serous 
or sero-fibrinous synovitis, as well as in inflammatory degen- 
erative articular changes during a chronic course (arthritis pan- 


PYEMIC AND SEPTIC ARTHRITIS 245 


nosa and deformans ); a suppurative synovitis is seldom observed. 
Asarulethe attack is simultaneous inseveral joints. 
In the acute course one finds the synovial membrane highly reddened, 
even hemorrhagic, turbid, swollen and thickened, the articular papillz 
are vascular and enlarged. The amount of the synovial fluid is in- 
creased, reddish in color, and often cloudy. In the early stages the 
articular cartilages are very red ; later they become yellow and present 
a rough, velvet-like surface. The tissues in the vicinity of the joint 
also present an injected appearance, they are permeated with hemor- 
rhages and infiltrated with serum (periarthritis); the connective tissue, 
especially, is affected with a gelatinous swelling, the adjacent muscles 
are edematous and soft. The articular ends of the bone are hyperemic 
and even infiltrated with hemorrhages; the same is true of the bone- 
matrow. Inthe.chronic type the synovial membrane becomes markedly 
thickened, and the inner surface of the joint is covered with a vascular 
connective-tissue layer (arthritis pannosa); the articular cartilage un- 
dergoes fatty degeneration, presents ulcerative losses of substance, and 
becomes partly loosened. In other cases there develops, asin man, an 
arthritis deformans. In dogs suffering from articular rheumatism there 
have been observed adhesions between the bones of the carpus and 
metacarpus, as well as irregular osteophytic formations. General 
changes occasionally occur in the body in the form of an endocarditis, 
pleuritis and peritonitis. Treatment is internal. It consists in the 
administration of large doses of natrium salicylicum (horses and 
cattle 100 grams, dogs 2 to 8 grams, per day), salol, antifebrin, 
antipyrin, salipyrin, etc. (see articular rheumatism: Fried- 
berger and Frobhner, ‘Special Pathology of the Domestic Ani- 
mals,’’ 1904, 6 Ed., Vol. I). 

PYEMIC AND SEPTIC ARTHRITIS OF YOUNG ANIMALS.—Pyemic 
and septic polyarthritis, formerly known as ‘‘foal-lameness’’, (foals, 
calves, lambs, pigs, puppies) develops metastatically from a septic infec- 
tion of the navel-wound; it is the result of improper care of the navel. 
Staphylococcus pyogenes aureus (Sohnle), and streptococcus pyo- 
genes (Ostertag) have been demonstrated as the infectious irritant. 
A few days or weeks after birth there developsan omphalitis with 
suppurative thrombophlebitis and thromboarteritis 
which soon leads to a general infection of the body (septicemia, 
pyemia). After previous febrile symptoms of a general disturbance 
swellings develop rapidly and simultaneously on several joints, 
especially the carpus, tarsus, knee, elbow, and hip; the swellings are 
accompanied by lameness and finally lead to abscess formation. Most 
animals die in the course of two or three weeks from septic diar- 
rhea or internal pyemic metastases. On post mortem 
one finds lesions of a suppurative, sero-purulent, or sero-fibrinous 
polyarthritis, in addition to changes characteristic of pyemic processes 
(pyemic form); in other cases the changes are more typical of se pti- 


246 PERIARTHRITIS 


cemia (septic form). When the navel-wound is not already healed 
it shows traces of inflammation and suppuration, the umbili- 
cal cord and the tissues surrounding the umbilicus are swollen, the 
margins of the umbilical ring present ulcerative thickenings, abscess 
formation has taken place within the umbilical ring, drops of pus 
may be pressed out of the umbilical opening. In addition to this. 
omphalitis, which may also heal, so that it presents no 
external symptom of disease, there exists in the 
deeper tissues a suppurative thrombophlebitis and 
thromboarteritis umbilicalis withthrombosis ofthe 
portal vein and its hepatic branches. The synovial membranes of 
the joints are injected, swollen, and thickened ; the fluids of the 
joints are cloudy, increased in amount, mixed with a floculent coagulum, 
and are often purely suppurative in character (empyema of the joint); 
the articular cartilages undergo ulceratiyvyerdemer. 
eratio n; at times the bone itself becomes necrotic 
occasionally the joint-capsules are perforated. Sup- 
purative osteomyelitic foci are found in the bones. Abscesses form 
between the muscles and tendons in the vicinity of the joint, the 
muscles may even undergo suppurative liquefaction. The muscles 
over the diseased joint are affected with fatty degeneration. The 
most typical examples of this disease are seen in the knee-, tarsal-, 
and occipito-atloid articulations. In addition, post mortem examina- 
tion reveals metastatic foci in nearly all the organs, especially 
inthe liver, lungs, and brain, the kidneys, inthe muscles, 
and inthe subcutaneous cellulartissues. In the liver these 
foci are from the size of a millet-seed to that of a cherry and larger, in 
the lungs from the size of a millet-seed to that of'a hen’s egg ; in the early 
stages they are dark-red, afterwards becoming yellow (so-called suppura- 
tion of the lungs). The following diseases have also been observed : 
pleuritis, endocarditis, pericarditis, bronchopneu- 
monia, inflammation of the tendon-sheaths, peri- 
tonitis, cystitis, suppurative iritis, panophthalmia, 
leptomeningitis, etc.—Treatment is essentially prophylactic : 
disinfection of the umbilicus and stall, ligation of the umbilicus. (For 
further information see: Friedberger and Frohner, ‘Special 
Pathology of the Domestic Animals’’. 1904, 6 Ed., Vol. I). 

ARTHRITIS Urica.—This is an arthritis due to the presence of 
urates in the joints(gout). It is a metabolic process the nature of 
which is not yet fully understood ; it occurs in man and birds, and 
occasionally in dogs. 

PERIARTHRITIS.—Periarthritis is an inflammation of the soft tissues 
surrounding the joint, especially the periosteum; the points of 
attachment of the capsular and lateral ligaments, the 
posterior ligaments, and the suspensory ligaments, 
the neighboring tendon-sheaths, and mucous bursae,.as well as the 


LUXATION 247 


parasynovial connective tissue. A form of periarthritis which is of 
great practical importance in the horse is that type which frequently 
attacks the insertions of the lateral ligaments and the capsular ligament at 
the coronary joint, designated as so-called periarticular or false 
ringbone (see page 241); the carpal tumors (false tumor albus), 
described as a schlerotic inflammation of the periarticular connective 
tissue, the tendon-sheaths, and the subcutis of the carpal-joints of cattle ; 
as well as many alleged inflammations of the tarsal-, fetlock-, coronary-, 
and pedal-joints in the horse. According to Siedamgrotzky 
ninety per cent of all cases diagnosed as inflammation of the phalangeal 
joints are periarthritis—that is inflammation of individual groups of liga- 
ments without involving the synovial membranes or the articular sur- 
faces. The following groupsare frequently implicated : the internal and 
external lateral ligaments of the pedal-joint, the external and internal 
suspensory ligaments of the navicular bone and lateral cartilages, the 
lateral navicular ligaments, the lateral ligaments of the second phalanx, 
as well as the suspensory apparatus of the first phalanx. Karnbach has 
demonstrated that genuine chronic deforming arthritis of the pedal-joint 
(ringbone of the pedal-joint) is not uncommon. 


Me CHOANGESeIN POSITION OF JOINTS». LUXATION, 


DISTORSION, CONTUSION. 
i] sGUsALION OR DISLOCATION. 


DEFINITION.—Luxation or dislocation isa persistent 
separation of both articular ends after over- 
Coming’ the restraining:-mechanism. If the dis- 
location is only partial so that the articular surfaces are not 
completely separated, it is termed a subluxation or in- 
complete luxation. A simple dislocation, in contrast 
toa complicated, is not accompanied by severe injuries, 
especially fractures. One further recognizes a recent and 
old, as wellasrecurrent or habitual luxation. Dias- 
tasis is aterm which designates a luxation of a false joint or 
half-joint, for example, the sacro-iliac joint in cattle. For- 
merly a change in position of the lens was termed luxatio lentis ; 
that of the bulb, luxatio bulbis. 

CAUSES.—One distinguishes traumatic, spontane- 
Giseeor pathological, and congenital luxations. 


248 LUXATION - 


a) Traumatic dislocations are due to the influence 
of external forces; they may be indirect through abnormal 
flexion, extension, or rotation of the articular ends by means 
of a leverage; or direct, as the result of kicks and blows. 
Occasionally luxations in horses are due to muscular force, 
for example, the patella may be dislocated upwards asa result 
of severe contraction of the quadriceps femoris when the 
animal is kicking. One most frequently observes traumatic 
luxations of the hip-joint in dogs and cattle (less frequently 
in horses); of the cervical vertebrez in horses and dogs ; of the 
patella in horses; of the inferior maxilla in carnivora, as well 
as of the elbow-joint in puppies. Dislocation of the fetlock- 
joint in race-horses is seemingly rare. 

b) Spontaneous or pathological luxations are 
due to disease or inflammation of the joint, atony or abnormal 
stretching of the joint-capsule and articular ligaments, hydrops 
of the joint, flattening of the articular condyles, as well as 
deforming arthritis. Habitual luxation of the patella in the 
horse is an example of this class, In human surgery various 
forms of pathological dislocations are recognized: disten- 
tion-luxation occursin hydrops of the joint as a result 
of stretching and atony of the joint-capsule and articular 
ligaments; destruction-luxation after suppurative 
liquefaction of the articular ends (joint-caries); deforma - 
tion-luxation as aresult of deforming inflammation of 
the joint (loose-jointed). 

c) Congenital luxations are usually due to arrested 
development ; they seldom occur during birth asa result of 
faulty manipulations. In many cases itis difficult to deter- 
mine whether luxation of the patella in the horse is due toa 
congenital or acquired flattening of the articular surface of the 
internal condyle of the femur, or to congenital and acquired 
overextension and atony (distorsion) of the joint-capsule 
and articular ligaments, with enlargement of the articular 
cavity. 

Symptroms.—Luxation of the joints of the extremities is 
characterized by lameness, as wellas by restriction, 
or abnormally free movement of the dislocated 


LUXATION 249 


joint. In upward luxation of the patella, for example, the 
knee-joint is abnormally extended and cannot be flexed; ex- 
ternal luxation, on the other hand, results in excessive flexion, 
the limb is unable to support weight. Luxation of the inferior 
maxillain dogs is characterized by inability to close the mouth. 
Upward luxation of the femur results in shortening of the 
affected limb. In dogs the decrease in length may be easily 
determined as follows: with the animal in the standing posi- 
tion extend the knee-joints equally and compare the positions 
of the tarsi or the paws. Inspection and palpation 
of the articular ends and comparison with the normal 
joint of the opposite side are also important diagnostic meth- 
ods. In upward luxation of the right femur of the dog, the 
trocanters, especially the greater trocanter, are higher than 
those of the opposite side; this is readily determined by: 
inspection or by palpation with the thumbs. The other 
Sianges in. the form of the joint, as well as: 
Mmiercnanged position of the dislocated: bones, 
and the changed position of the entire limb, may indicate the 
presence of a dislocation. In general a dislocation may be 
differentiated from a fracture by the absence of crepitation. 

Complicated luxations may be associated with frac- 
ture of the dislocated bones, especially the glenoid margins 
of the hip-joints, the cervical vertebrze, and the occipital bone ; 
Or with severe injuries to vital organs, especially the spinal 
cord in luxation of the vertebral column ; or finally, with 
laceration of the skin and the soft tissues surrounding the 
joint. In animals rupture of the skin seems to be uncommon. 
Smith describes a case of luxation of the fetlock-joint in the 
horse in which the metacarptts penetrated the skin and was 
driven into the ground to a depth of four inches. 

Diastases are observed in cattle at the sacro-iliac joint 
and at the pubic symphysis, and-in the vertebral column of 
horses as a result of rupture of the intervertebral ligaments. 
Complete diastasis of the sacro-iliac joint results in a detach- 
ment of the tense, almost immoveable union between the sacrum 
and the ilium, so that the sacrum sinks downwards and results 
in stenosis of the pelvic canal. On rectal examinations the 


250 LUXATION 


promontory is found to be directed downwards; viewed from 
without the vertebral column seems to have dropped while 
the internal angles of the ilium are abnormally prominent. 
Diastasis of the pubic symphysis may also be recognized from 
the rectum. In horses rupture of the sacro-iliac ligaments. 
results in a form of so-called sacral weakness or sacral paralysis. 

ANATOMICAL CHANGES.—Luxations, with the exception 
of the patella, usually resultin laceration of the cap- 
sule, and partial or complete rupture of the lateral and 
accessory ligaments. Luxations of the hip-joint are 
characterized by rupture of the capsular ligament and 
usually a rupture or tearing away of the round ligament. 
Rupture of the joint-capsule leadsto hemorrhage within 
and around the joint; rupture and hemorrhage may 
also occur in the neighboring soft tissues, muscles, connective 
tissue, etc. Fractures are also observed, especially on the 
acetabular margins of the hip-joint. Spontaneous luxations are 
characterized by chronic inflammatory changes in the joint. 

If reposition of the dislocated joint-surfaces is not pro- 
duced a new joint is formed in the vicinity of the dislocated 
ends (nearthrosis). In the vicinity of the hip-joint, 
especially, the proximal extremity of the dislocated femur is. 
surrounded by an inflammatory tissue formation which is 
very similar to a joint-capsule; at the same time a new aceta- 
bulum with a cartilaginous covering results from proliferation 
of the periosteum of the pelvis. Nearthrosis formation is. 
most frequently observed after dislocation of the hip-joint in 
dogs; it is occasionally observed in horses. In a horse 
affected with chronic hip-lameness Kitt found the following 
conditions: A loose, one half to two centimeters thick, con- 
nective-tissue sac, which performed the function of a joint- 
capsule in the region of the acetabulum ; enlargement of the 
joint-cavity in the direction of the shaft of the ilium; the 
articular surface of the femur was worn smooth. 

TREATMENT.—As in fractures, treatment of dislocations 
consists on the one hand, in reposition; on the other, in 
retention of the dislocated ends. Healing depends on these 
fundamental principles. Recent simple luxations heal rapidly 


LUXATION 251 


when both conditions are fulfilled; the ruptured capsule is. 
soon closed, the intra- and extracapsular hemorrhage is rapidly 
resorbed. Unfortunately, with the exception of a dislocated 
patella, reposition and retention is more difficult in animals 
than in man. Reposition of the hip-joint, in particular, is 
very difficult in well muscled horses and cattle, even with a 
set of pulley-blocks it is not always possible to overcome the 
mechanical resistance ; the application of a retention bandage 
is also more difficult than for fractures. Retention of a reduced 
hip-joint is not easy to accomplish even in dogs, as they will 
not remain quiet. Relatively speaking the following luxations 
are most easily reduced: the patella and first phalanx in the 
horse, and the inferior maxilla in the dog. In all old luxations, 
of which luxation of the hip-joint in the dog is a frequent 
example, no experiments with reposition and retention are 
made ; even apparently severe dislocations of the articular 
head develop very rapidly into a nearthrosis, so that the limb 
can be used again in a relatively short time. I have also 
observed one case of spontaneous healing in luxation of the 
hip in a horse. Arthrotomy and resection of the 
joint, as employed in human surgery, is not usually applicable 
for domestic animals (in the horse I have twice performed 
resection of the maxillary-joint with good results). The suc- 
cess and results of separation of the internal lateral ligament 
of the patella, for upward dislocation of that bone, are yet to be 
demonstrated. 


STATISTICS OF LUXATIONS.—I. Inthe horse the number of luxa- 
tions is small when compared with other abnormal positions of the joints, 
especially distorsions; the same is true when compared with other diseases. 
of the joints. There is an average of about one luxation to 
fifty distorsions. In a thousand cases of diseases of 
the joints, there is about one luxation. The following 
statistics-are compiled from the military records of the Prussian Army: In 
ten years, 1886-1897, of 300,000 diseased horses in the service, over 36,000 
cases included affections of the joints; of these, 15,000 were dis- 
torsions, while only 320 were luxations. With reference tothe 
Securrenuce of luxations in different joimts, statistics 
indicate that the patella is by far the most frequent seat. The 
fetlock-joint is second. Of 7,000 horses brought to the Berlin 
Surgical Clinic, I have observed only five luxations of the femur, as 
as well as two luxations of the patella and fetlock-joint. 


252 DISTORSION 


2. Luxationsare much more frequent in dogs than in horses. Of 
the 70,000 dogs treated by me in the Berlin Dog Hospital during a 
period of nine years (1886-1895) there were 344 luxations (equal to 0.5 per 
cent of all the cases) and 579 distorsions (equal to 0.8 per cent of all cases). 
Asa rule, in dogs the dislocation is at the hip-joint. 


2. DISTORSION OR SPRAIN. 


NATURE AND Symptoms.—A distorsion or sprain is a 
momentary separation of two articular surfaces in con- 
trast toa permanent deviation of aluxation. As in luxations, 
they are designated as simple and complicated, that 
is, combined with severe injuries, especially fractures. 

The causes of. distorsion are the same as those of 
dislocation, they wary only in degree, less force is exerted. 


The anatomical changes in the joint are essentially the 


same as those accompanying dislocations. Simple distor- 
sions lead to stretching and even lacerationm 
of the joint-capsule and the ligaments oO gna 
joint,aswellasto hemorrhage within and out- 
side the joint. These conditions often account for the 
chronic course of many distorsions; if a fracture also exists 
the distorsion may be incurable as joint-fractures are not 
amenable to treatment. 

The symptoms consistin sudden lameness, as 
the causes are usually due to an overstretching or forcible 
rotation (oblique position, knuckling over, being caught in the 
rails, etc.). Palpation of the joint by means of passive 
movements, especially rotation, produces severe pain; in 
addition, there is increased heat and swelling in 
the joint (very frequently this is visible only after twenty- 
four hours). Because of these symptoms, which are also 
characteristic of inflammation of the. joint, the case may be 
diagnosed as arthritis instead of distorsion. Crepitation and 
abnormal mobility, as well as permanent changes in position 
are not present in simple distorsions; on the other hand, 
crepitation may accompany complicated distorsions. 

The course varies according to the severity of the 
anatomical changes. If there is only a slight overextension 


CONTUSION 253 


ot the joint-capsule and articular ligaments, without a rupture 
of the same, lameness may disappear in a few days. If, how- 
ever, the joint-capsule is severely ruptured, the articular carti- 
lage bruised, and extensive hemorrhage has taken place within 
and outside the capsule, healing requires several weeks or 
even months. There develops a chronic, partly ulcera- 
tive, partly deforming arthritis (ringbone for 
example), and even anchylosis of the joint so that 
healing becomes impossible. As has been remarked, compli- 
cated distorsions are often incurable. For these reasons 
the prognosis of -any distorsion should be 
sivenewith caution. . 

TREATMENT.—Recent distorsions are treated with rést, 
moist neatunthe form of Priesnitz compress, 
massage, compression, and plaster-of-Paris 
bandage. If the healing of distorsions is delayed, two or 
three weeks for example—if the lameness still remains — 
blisters and firing may beemployed. Neurectomy 


remains as a last resort for incurable cases. 

STATISTICS OF DISTORSIONS.—In horses, distorsions of the joint 
form one of the most frequent of joint-diseases. About half of all 
joint-diseases are distorsions. Inthe horse the fetlock- 
joint and coronary-joint are most frequently sprained. Accord- 
ing to the statistics of the Prussian Army, which are in harmony 
with the estimates of Stockfleth and Bayer, distorsions of 
Piemrettoc’®-joint are far more frequent than those 
of the coronary-joint. According to the Prussian Military 
Reports, in the years 1890-1897, there were 6000 distorsions of the fet- 
lock-joint and only 2100 of the coronary-joint. Inthe year 1900, of 
I9g00 cases of distorsion, 1100 involved the fetlock-joint and 600 the 
coronary-joint. In the year 1901 there were 940 distorsions of the 
fetlock-joint and only 611 of the coronary-joint. In contrast to this, 
Moller and Frick maintain that distorsions of the coronary-joint 
are more frequent. According to my own experience, distorsions of 
the fetlock are more frequent than those of the coronary-joint; of 120 
distorsions examined (1895-1898) , 70 were of the fetlock-joint, 50 of the 
coronary-joint. Both joints are often involved at the same time. 


3. CONTUSIONS OR BRUISES OF THE JOINT. 


NATURE AND SyMPTOMS.—A joint contusion is a bruising 
of the joint; it may occur directly by means of pressure, 


254 ANCHYLOSIS AND CONTRACTURE 


blows, and kicks directly over the joint, or indirectly by 
means of concussions and shocks which are operative at some 
point below the joint and result in compression of the articular 
surfaces. In the first case there exists a contusion and 
inflammation of the capsular ligament and the periarticular 
tissue ; in the latter, a contusion of articular cartilage, which 
in severe cases may be associated with a fracture of the articular 
ends. 

The symptoms of joint contusion are similar, though 
lesser in degree, todistorsions. The lameness in particular, 
and the amount of pain shown on palpation, are less than 
in luxation. On the other hand, contusions usually lead 
to severe hemorrhage into the joint (hemarthrosis), as 
well as to a large fluctuating swelling in the vicinity of 
the joint (contusion-swelling of the skin and subcutis). 

The course is usually more favorable than that of dis- 
torsions ; ordinarily resorption of the blood-extravasate in 
the joint is rapid ; function is entirely restored. At times a 
hydrops of the joint may remain (joint-gall). The course is 
unfavorable only when the contusion is complicated with a 
fracture or joint-wound. 

TREATMENT.—Early massage and compression 
of the joint by means of a permanent or elastic bandage is the 
most appropriate treatment for contusions of the joint. Re- 
sorption may be favored by moist heat, and later with 
slight exercise. 


III. ANCHYLOSIS AND CONTRACTURE. 


I. ANCHYLOSIS OR STIFF JOINT. 


DEFINITION.—Anchylosis is an adhesion between two 
articular surfaces; it results in stiffness and immo- 
bility of the joint. In contrast to contracture of the joint, 
in which the mobility is only restricted, anchylosis implies a 
complete suspension of the motion. According to the char- 
acter of the connective substance at the point of adhesion, 
anchylosis is designated as follows: osseous, cartilagi- 


ANCHYLOSIS 255 


nous, and connective-tissue anchylosis (anchy- 
losis ossea, cartilaginea, and fibrosa). Anchy- 
losis ossea is sometimes erroneously termed synostosis. Ac- 
cording to the location of the anchylosed masses within or out- 
side the articular capsule, it is termed inner and outer 
(intracapsular and extracapsular) anchylosis. 
Thereis also a genuine and a false (apparent) anchylosis. 

Causxs.—Anchylosis formation is either the product ofa 
chronic arthritis, especially the deforming, pannous 
and granular types, or it is the result of a fracture involv- 
ing the joint. It is most often seen during the course of a 
deforming arthritis (spavin, ringbone); in ossifying periostitis 
in the vicinity of joints; as a result of periarthritis at the 
carpal-joint ; following ossification of the intervertebral carti- 
lages in old horses (causes of constrained movement in the sad- 
dle-region and of fractures of the vertebrze); as a result of poll- 
evil, which leads to adhesions between the cervical vertebrae 
and permanent stiffness of the neck ; and in chronic inflam- 
matory conditions of the inferior maxillary-joint. Occasion- 
ally one finds the inferior surface of the vertebral column 
of the horse covered with osseous proliferations from the size 
of a hazelnut to that of a hen’s egg; they are so closely bound 
together that the vertebree form a strong, immoveable column 
(saddle constraint). Adhesion between the eyelids, which is 
analogous to that between joints, is termed anchyloblepharon. 

TREATMENT.—In the domestic animals anchylosis is 
usually incurable. When a joint is anchylosed the mo- 
bility, pain, and lameness are suspended ; forthis reason, in 
veterinary medicine, certain chronie inflammations of the 
joint, especially spavin and ringbone, are treated with blisters 
and the cautery in an attempt to produce artificial anchy- 
losis of the joint. In man, anchylosis is treated in the 
eatly stages with massage, passive movements and extension 
of the joint under the influence of narcosis in an attempt to 
prevent permanent stiffness. Complete anchylosis is treated 
with resection of the joint, arthrotomy and osteotomy. 


256 JOINT CONTRACTURE 
2. JOINT CONTRACTURE (STILT-FOOT). 


DEFINITION.—The expression ‘‘contracture’’ designates 
an abnormal position of the joint in which free- 
dom of movement is permanently restricted 
(knuckling of the joint, stilt-foot). This should not be con- 
fused with contraction, that is, excessive muscular contraction. 

CAUSES AND Forms.—Restriction of the mobility of the 
joint may be due to the following causes: diseases of the 
joints, tendons, muscles, nerves, and skin, or it may be con- 
genital. One designates, therefore, the following forms of 
contracture: articular, tendinous, myogenic, 
neurogenic, cicatricial, and congenital Gomme 
tractus ¢'s. 

a) Articular contractures are due to pathological 
conditions of the joint itself, there is a restriction of the free 
mobility of the joint (articular stilt-foot). It may 
result from any of the following conditions : exostosis forma- 
tion and irregularities on the articular surfaces, inflammatory 
new-formations in the joint itself, arthritis deformans, free 
joint: bodies, first stages of anchylosis. In the horse one most 
frequently observes an articular contracture (articular stilt- 
foot) during the course of an articular ringbone, the osteophy- 
tic enlargements on the first and second phalanges, as well as 
the first stages of anchylosis, mechanically restrict free move- 
ment in the coronary-joint. The same condition is observed 
in unilateral chronic arthritis of the maxillary-joint which 
results in imperfect mastication on the side involved. 

b) Tendinous contractures are due to contraction 
and adhesion of the flexor tendons ; they follow a tendinitis 
(tendinous stilt-foot). In adult horses tendinous 
contractures are most often observed at the anterior fetlock- 
joint (knuckling in a narrow sense) as a result of chronic 
inflammation of the perforans tendon. 

c) Myogenic contractures are due to cicatricial retrac- 
tion of muscles as a result of previous ruptures and inflamma- 
tions. Contracture of the internal and external flexors of the 
carpus (flexor, and extensor carpi ulnaris) produces so-called 


JOINT CONTRACTURE 257 


“‘knee-sprung’’ in horses. Contracture of the mastoideo humer- 
alis results in an oblique position of the neck (caput obstipum). 
Unilateral contracture of the lateral coccygeal muscles causes 
the tail to be held to one side. Apparently many cases of 
acquired stilt-foot in colts are referable to a myogenic cause 
(rheumatism, rachitis). 

d) Neurogenic contractures result from derange- 
ments of the muscular innervation, they are due, either to 
paralysis and muscular weakness (paralytic neurogenic 
contracture), or to cramps ‘in certain groups of muscles 
(spastic neurogenic contracture). Congenital stilt-foot in 
foals (so-called knuckling) is due to a paralytic contracture 
(congenital weakness of the extensor muscles). This hypoth- 
esis explains the rapid recovery from stilt-foot in foals under 
proper treatment. The relative ease with which it may be 
cured does not sustain Johne’s hypothesis. He maintains 
that stilt-foot in foals is a tendinous contracture resulting from 
a faulty position of the flexor tendons in utero. 

e) Tissue or cicatricial contractures result from 
tissue-contraction following a wound, burn, cauterization and 
necrosis of the skin on the flexor surfaces of joints, as well as 
on the neck (caput obstipum). Therapeutics of this affection 
involves the same treatment as that employed in the operative 
treatment of entropion in dogs: cutting out a piece of skin 
(blepharoplasty ). 

f) Congenital contractures depend, either upona 
congenital muscular weakness (stilt-foot in foals), or upon a 
deranged development of the joints of the fetus. The latter 
conditions in domestic animals do not receive surgical treat- 
ment because young animals thus affected are not allowed to 
live. The following congenital forms of club-foot are 
recognized in man: (pes varus) an arthrogenous supination- 
contracture of the foot; flat-foot (pes valgus or planus), 
an abnormal dorsal flexion of the foot; horse-foot (pes 
equinus), an abnormal planter flexion of the foot. Genu 
valgum (x-formed limb) also occurs. 

TREATMENT.—Many cases of contracture are incurable ; 
by means of an operation many are partially curabie. This is 


258 JOINT BODIES 


especially true of tendinous contractures (tendinous stilt-foot) 
which may be benefited by tenotomy; and myogenic con- 
tractures (knee-sprung, crooked tail) which are occasionally 
improved by performing myotomy. The neurogenic con- 
tractures also (stilt-foot of foals) sometimes recover when prop- 
erly bandaged and massaged. Articular contractures (ring- 
bone), on the other hand, are incurable, even neurectomy 
is ineffective because restricted mobility is due to mechanical 
causes. 


DEFORMITIES OF THE VERTEBRAL COLUMN.—The following types 
of deformities of the vertebral column are sometimes congenital: 
kyphosis (hunip-back, carp-back); lordosis (hollow-back); 
scoliosis (lateral curvature of the spine); occasionally a combined 
form is seen (ky phoscoliosis). Bayer has described two cases 


in the horse, one to the left, the other to the right. Other cases have a. 


rachitic origin (see page 230). In mares, lordosis may result 
from repeated pregnancy, it may also result from pressure on the spinal 
column. According to Johne the vertebral column of cattle may 
occasionally rotate slightly on its long axis as a result of chronic 
tympanitis of the rumen (tuberculosis of the mediastinal glands). 

Deformities of the vertebral column may also be due to fractures, 
chronic inflammatory processes in the intervertebral joints, 
tuberculosis and new-formations. Hess has described a 
case of kyphosis in a steer that was caused by tuberculosis of the lumbar 
vertebree. An interesting case of dorso-lumbar curvature in the horse 
has been described by Vatel. The curvature of the spine had dislo- 
cated the kidneys, the posterior aorta was displaced downwards and 
dilated to form ananeurysm. The lumbo-sacral joint was affected with 
arthritis sicca and erosion of the cartilage, a bony tumor lay between 
the seventeenth and eighteenth ribs, the articular surfaces of the 
lumbar vertebree were anchylosed. Goubeaux has furnished an 
extensive work on ‘‘Deformitaten der Wirbelsaule bei den Haustieren.’’ 
(Recueil. 1886-87), 


IV. JOINT BODIES. CORPORA LIBERAG 


NATURE.—J oint-bodies (free bodies, corpora libera, 
joint-mice, mures articulorum, rice-like bodies, corpora ory- 
zoidea) are free or pedunculated smooth bodies situated in the 
joint-cavity. They vary in size from a millet-seed to that of a 
cucumber-seed, and are seldom as large as a dove’s egg, they 
have a white glistening color, and are of the consistency of 
cartilage or bone. ‘Their origin ts extremely variable: 


a 


DISEASES OF TENDONS AND TENDON-SHEATHS 259 


1. Arthritis deformans and osteochondritis 
dessicans (coagulation necrosis) form the most frequent 
‘causes of joint-bodies ; circumscribed particles of the articu- 
lar cartilage are sloughed off. 

2. Others are the product of an inflammatory swelling 
and a connective-tissue cartilaginous and osseous prolifera- 
tion of the articular villi, especially the cartilaginous 
villi, which are subsequently torn away or constricted. 

3. Others occur from sloughing away of pieces of 
cartilage or bone in complicated distorsions, luxations 
and contusions of the joint. 

4. Many are formed by coagulation and organization of 
masses of fibrinous exudate (corpora oryzoidea). 

5. Inrarecases extracapsular new-formations 
(exostoses; lipoma) grow into the joint-cavity and become 
constricted. 

Symptoms.—The occurrence of these foreign bodies is 
very rare. When they are suddenly brought between the 
articular surfaces the following symptoms may result: lame- 
ness, which develops suddenly without any appa- 
rent cause, andas suddenly disappears, remit- 
tent lameness. Diagnosis during life is extremely difficult. 
Stockfleth found corpora libera in the knee- and tarsal- 
joints of the horse; Bruckmuller in the shoulder- and 
carpal-joints; Moller founda body as large as a dove’s egg 
in the knee-joint of a horse. 

Treatment in the horse is impossible. In dogs, as in 
man, arthrotomy may be tried. 


DISEASES OF THE TENDONS, TENDON-SHEATHS, 
AND MUCOUS BURSZ. 


PRELIMINARY REMARKS ON ANATOMY AND PHYSIOLOGY. 


TENDONS.—The tendons consist of fine tendon-fibrillae 
which are bound by a cement-like substance into slender tendon- 
fibers. Through the adhesion of numerous tendon-fibers tendon- 
fasciculi (primary tendon-bundles) are formed. Several 
fasciculi are surrounded by epitendineum to form secondary bun- 


260 DISEASES OF TENDONS AND TENDON-SHEATHS 


dles ; epitendineum is a loose connective-tissue layer containing a few 
blood-vessels.. The secondary bundles are combined in a similar man- 
ner to form tertiary tendon-bundles out of which the tendon is 
composed. The surface of the tendon is covered with paratend- 
ineum, a loose connective-tissue layer. From a surgical standpoint 
the following tendons are of great practical importance: the flexor 
tendons of the phalanges ; namely, the suspensory ligaments 
(superior sesamoid ligament), the flexor perforans and per- 
foratus. The anatomy and physiology of the tendons under con- 
sideration, which may be regarded as supporting ligaments of the 
phalangeal joints, are of great importance for an understanding of the 
pathogenesis, symptomatology, and therapy of diseased tendons. A 
valuable contribution to this knowledge has recently been supplied by 
Stoss (Anatomie und Physiologie der Phalangenbander des Pferdes. 
Monatshefte fur praktische Tierheilkunde, 1895). According to this. 
article the flexor of the first phalanx (so-called superior 
sesamoid ligament) is primarily a volar interosseous muscle, flexor of 
the first phalanx, and the most highly developed type of supporting 
ligament, it prevents overextension of the fetlock-joint (so-called dorsal 
flexion of the fetlock-joint). The flexor of the first phalanx is attached 
to the postero-superior extremity of the metacarpus at one end and to 
the sesamoid bones at the other. In the same manner the flexors of 
the second and third phalanges form supporting ligaments 
for the coronary- and pedal-joints. The so-called check ligaments 
of the same prevent overstretching of the flexor muscles from the body 
weight, and perform the same function for the coronary- and pedal- 
joints as that performed by the suspensory ligament for the fetlock- 
joint. The check ligament of the flexor perforans arises from the 
thickened posterior capsule of the carpal-joint; that of the flexor 
perforatus from the radius above the carpal-joint. 

TENDON-SHEATHS AND Mucous BuRSaé.—For surgery, the anat- 
omy or tendon-sheaths and mucous burse is extremely important. In 
most text-books on veterinary anatomy the arrangement is neither 
detailed nor distinct. The following isa short description of the most 
important relations in the horse according to Kichbaum (Berlin 
Archiv. 1883). The physiological function of tendon-sheaths and 
mucous bursz consists in facilitating the gliding movements of the 
tendons, muscles, and skin, especially where they pass over projecting 
areas. The physiological function has a common relation to the 
anatomical and histological structure; they vary only in external form. 
They may fuse with one another, they hdve no constant structure, and 
they may communicate with joints (for example, the tendon-sheath of 
the extensor digitorum communis with the knee-joint); further, mucous 
bursze may develop into tendon-sheaths. 


DISEASES OF TENDONS AND TENDON-SHEATHS 261 


The tendon-sheaths (burse vaginalis, vagine tendineum) 
form cylindrical sacs which isolate the tendons by means of sheath-like 
coverings at points where they pass over extensor or flexor surfaces of 
articulations. Occasionally several tendons are enclosed in one sheath, 
namely, the tendons of the perforans and perforatus at the posterior 
surface of the carpus and metacarpus. Similar to joint-capsules the ten- 
don-sheaths are lined on their inner surfaces with synovial mem- 
branes (serous sheath, mucous sheath), which represent serous 
membrane, in that they are lined withasingle layer of endo- 
thelium (by others, they are regarded as glandular, mucus 
secreting organs). The external layer of the tendon-sheath has a 
fibrous covering which is bound to the synovial membrane by means of 
connective tissue. 

The mucous-bursae (burse mucose) form round sacs flat- 
tened laterally ; they aresituated beneath tendons, muscles, and skin ; 
their inner walls are usually smooth, sometimes rough and net-like from 
papille and projecting tendon-fibers, or they have the appearance of a 
fenestrated membrane. Two forms of mucous bursz are recognized. 
1 Bursae mucosae subtendinae (burse subtendine), which, 
because of their seemingly constant occurrence, are also termed ‘‘typi- 
cal’? mucous bursee. They are situated at the points of origin and in- 
sertion of muscles and tendons; beneath these organs and in close con- 
tact with them. Like tendon sheaths, their inner surfaces are covered 
with a layer of endothelium ; in old horses they frequently communi- 
cate with tendon-sheaths and joints, in these cases they form a blind, 
sac-like protrusion of the joint-capsule (bursze synovialis). The exist- 
ence of this combination is of great importance in certain surgical 
affections (galls). Bursze subtendinee are usually present in foals. The 
following are of special surgical importance: the bursa intertubercularis 
of the biceps in front of the shoulder-joint, and the subtendinous bursa 
of the flexor perforatus at the calcaneum. 2. Bursae mucosae 
subcutanae (burse subcutanze), because of their inconstant occur- 
rence, are also termed ‘‘atypical’’ mucous burse ; they develop after 
birth (‘‘acquired’’ mucous bursz) and increase in number with the age 
of the animal. Apparently their origin is due to ruptures of the sub- 
cutaneous connective tissue ; this is produced by extension and flexion 
of the joint, especially through laceration of the subcutis over osseous 
tuberosities ; laceration leads to encapsulation. The inner surfaces of 
these acquired mucous bursae contain, therefore, in most cases, no 
endothelial layer. They are found in all places where the skin is 
moveable over osseous tuberosities, especially on the olecranon (shoe- 
boil), caleaneum (capped-hock), and on the external angle of the ilium. 
They are less frequently seen in the following places: on the patella, 
malleoli, withers, sacrum, and on the extensor surfaces of joints. 

The following mucous bursae and tendon-sheaths 
are of great surgical importance: 


262 DISEASES OF TENDONS AND TENDON-SHEATHS 


I. Heap.—The subcutaneous bursae onthe crest of 
the occipital bone (neck-tumors in dogs), 

Il. NEcK.—The bursa mucosa beneath the origin of 
the ligamentum nuchae, between the cervical ligament and 
the superior surface of the atlas and its capsular ligament. It 
varies in length from three to ten centimeters, is oval in form, and 
bounded laterally by the middle extensors of the head. A second 
bursa mucosa issituated beneath the cordiform portion of 
the ligamentum nuchae inthe region of the second cervical 
vertebra ; it is about the size of an apple, and lies between the cordi- 
form portion of the cervical ligament and the points of attachment of 
the lamellar portions of the cervical ligament to the crest of the second 
cervical vertebra. It is bounded on both sides by the complexus. 
muscles (poll-evil in horses). : 

III. TRUNK.—A mucous bursa lies above and on both sides 
of the withers (fifth to seventh dorsal vertebre, fistulous withers). 
There is a mucous bursa over the external angle of the 
ilium—bursa iliaca lateralis—both upon the superior and the 
inferior tuberosities of the same; the superior is ten centimeters long,, 
and fourto five centimeters wide. A third mucous bursa leson 
the tuberosity of the ischium—bursa tuberis ischii— 
it is the size of a walnut (hygroma formation). 

IV. ANTERIOR EXTREMITIES.—A subtendinous bursa lies 
under the insertion of the infraspinatus muscle (bursitis infra- 
spinati). A bursa mucosa lies between the tendinous origin of the 
biceps brachii and the trochlea of the humerus—bursa 
intertubercularis—(bursitis intertubercularis). A very important 
bursa mucosa lies on the posterior surface of the olecranon process 
of the ulna, bursa olecrani; it is very common, from the size of a 
walnut to that of an apple, it has vaginal walls and several compart- 
ments; occasionally it is situated more on the lateral side of the olecra- 
non process of the ulna (shoe-boil). The following are important: the 
tendon-sheath of the extensor pedis on the anterior surface 
of the carpal-joint; the tendon-sheath of the extensor suf- 
fraginis (at the same place); the tendon-sheath of the 
middle extensor of the carpus; the tendon-sheath 
of the oblique extensor of the carpus; the tenia 
sheath of the external flexor of the carpus (M’exvem- 
sor carpi ulnaris); a subcutaneous bursa mucosa on 
the anterior surface of the carpal-joint in cattle (‘‘knee tumor’’); the 
tendon-sheath of the perforans and perforatus, this 
is very large, situated largely in the carpal sheath, it begins about ten 
centimeters above the carpal-joint and passes downwards as far as the 
point of attachment of the check ligament to the perforans tendon (galls. 
of the flexors at the carpus), tenotomy should be performed below this. 
tendon-sheath; the tendon-sheath of the flexor of the 


DISEASES OF TENDONS AND TENDON-SHEATHS 263 


carpus (M. flexor carpi radialis); the bursa mucosa on the 
wearteriog Sutface of the inferior extremity of the 
Mmetscarpus and metatarsus; the common tendon- 
Sureath or the flexor pérforans and perforatus, ' it 
begins ten centimeters above the fetlock-joint, passes over the posterior 
surface of the superior sesamoid ligament, the sesamoid bones, the first 
and second phalanges, and ends at about the middle of the second 
phalanx (perform tenotomy above this tendon-sheath); the bursa 
mucosa subtendinea on both lateral surfaces of the first phalanx, 

Finally, the bursa podotrochlearis is of great importance, 
this is a mucous bursa beneath the insertion of the perforans 
tendon; it begins at the posterior margin of the navicular bone and 
reaches to the pedal attachment of the flexor perforans. It formsa closed 
sac that does not communicate with the pedal-joint ; the anterior wall 
covers the posterior surface of the navicular bone, while the posterior 
wall is in contact with the flexor tendon (bursitis podotrochlearis). 

V. POSTERIOR EXTREMITIES.—The bursa glutei medii (tro- 
chanterica) isa mucous bursa beneath the end insertion of the 
gluteus medius and maximus on the middle trocanter; it 
forms a circumscribed sac on the outer smooth surface of the middle 
trocanter (bursitis trocanterica). At the knee-joint is situated the 
bursa mucosa subcutanea in front of the patella(bursa 
prepatellaris), itis present in only fifty per cent of all horses, and 
varies in size from that of a bean to that of a walnut. It is located on the 
anterior surfaceof the patella, usually on the projecting upper 
half, and occasionally extends to the lateral border of the patella (bursitis 
prepatellaris). There is also a mucous bursa on the tibia beneath 
faeinsettiouvor tue-middle straight ligament of tke 
patella, bursa subpatellaris (bursitis subpatellaris). The follow- 
ing are of practical importance: the synovial bursa beneath the 
origin of the flexor metatarsi and long extensor of the 
toe, about fourteen centimeters long, large, it is located immediately 
below the knee and communicates with the knee-joint; the bursa 
mucosasubcutanea above the tuberosity of the calcan- 
eum—bursa calcanei, this is very common, though not constant, 
oval in form, four to five centimeters long, three to four centimeters 
wide, and lies on the posterior surface of the upper end of the calcaneum 
(capped-hock); the tendon-sheath of the lateral extensor 
of the toe, this begins two to four centimeters above the lateral 
maleolus and terminates on the upper surface of the metatarsus (string- 
halt operation); the tendon-sheath of the long extensor 
of the toe passes over the anterior surface of the tarsal-joint to the 
point of attachment of the lateral extensor to the long extensor; the 
mucous bursa under the inner branch of the tibialis 
anticus is roundish in form, the inner wall covers the medial surface 
of the cuneiform bones and pyramidal bone, the outer wall surrounds 


264 DISEASES OF TENDONS 


the branch of insertion (spavin-operation); the tendon-sheath of 
the flexor perforans begins about the width of three fingers 
above the medial maleolus, passes down the posterior surface of the tibia 
and the tarsal-joint, and ends just above the point of attachment of the 
lateral flexor to the tendon of the flexor perforans (inflammations, 
galls); the tendon-sheath of the lateral flexor arises 
at the middle of the tibia on the medial side, it is from thirty to 
thirty-five centimeters in length, passes down the medial surface of the 
tarsal-joint to the pyramidal bone and terminates at the point where this 
tendon is attached to the perforans; the tendon-sheath beneath 
the tendon of the perforatus lies between the cap-like expan- 
sion of the latter and the calcaneum, it terminates at the middle of the 
calcaneum (curb). 


I DISEASES OF TENDON 
I. INFLAMMATION OF. TENDONS. ‘TENDINITIS. TENONITIS. 


CausEs.—Inflainmations of tendons occur most frequently 
in horses; they are caused by strains, overexten- 
sions, and partial ruptures of the tendons as a result 
of overexertion in race-horses, trotters, and heavy draft-horses. 
Direct contusions of tendons from blows are uncommon. In 
most cases tendinitis is primarily traumatic in character; 
as it is not accompanied by an injury to the skin, it is not 
under the influence of bacteria and is, therefore, aseptic. 
It has its analogues in the similar traumatic and aseptic bone- 
fissures, the processes of healing are similar. The following 
conditions predispose to tendinitis : abnormal positions, 
especially too long and too weak fetlocks; low heels and long 
toes ; imperfectly developed tendons ; deranged nourishment of 
the tendons as a result of somie previous disease, or standing 
for a long time. 

In other cases the inflammatory process pro- 
ceeds from neighboring tissues to the tendons. 
Primary inflammation of the tendon-sheaths (contagious 
pleuropneumonia) often results ina secondary tendinitis. 
In a similar manner phlegmonous inflammations of the tendon- 
sheaths from phlegmon of the fatty frog may lead to tendinitis, 
it may also occur during the process of bursitis podotrochlearis 
and sesamoid lameness (suppurative and necrotic ten- 


TENDINITIS 265 


dinitis). Tendinitis resulting from inflammation of the tendon- 
sheaths, when the latter is secondary to infectious diseases 


(contagious pleuropneumonia), is erroneously termed metastatic 
tendinitis. 


Filaria cincinnata (spiroptera reticulata) 
is rarely the cause of tendinitis. It is seen in the suspensory 
ligaments of Russian and Italian horses, and occasionally 
results in inflammation and lameness, as well as in fibroma- 
like new-formations (see page 183), 

PATHOLOGY.—In recent traumatic tendon-inflammations 
one first finds a partial fascicular rupture of the ten- 
don-fibers witha trivial extravasation of blood, or a 
sanguino-serous infiltration of the interfascicular connective tis- 
sue. The inflammatory reaction which soon follows is char- 
acterized by hyperemia, bloody infiltration, and new-formation 
‘of blood-vessels and connective tissue (tendinitis f1- 
brosa). Granulation tissue is formed from the following 
structures: the paratendineum, the adjacent tendon-sheaths, 
the interfascicular connective tissue (epitendineum ), in part, 
also from the genuine tendon-cells of the ruptured tendon- 
fibers. The voluminous, vascular, semi-solid granulation tissue 
undergoes a partial atrophy of the tendon-fibers; the soft 
embryonic tissue is transformed into hard, crepitating, nodular 
connective tissue, which is partly cartilaginous and osseous and 
which forms a typical tendon-cicatrix (tendon-callus, 
schlerosistendinum). At the same time there may 
occura contraction, and adhesion of the tendon to the 
adjacent structures. Necrosis may readily follow suppura- 
tive inflammation of tendons. 

Symproms.—Tendinitis occurs principally inthe flexor 
tendons (perforatus, perforans, and suspensory ligament); 
it is much more frequent in the anterior limbs. In horses it is 
characterized by lameness, which develops suddenly, or 
gradually increases in severity, volar flexion is pro- 
nounced. There is pain on palpation, increase of local 
temperature, and in the early stages a semi-solid 
swelling on that part of the tendon involved, the skin is 
moveable on the surface. Later there is an increase in the 


266 TENDINITIS 


consistency of the swollen tendon. If resolution does not take 
place in the swelling, there remains, after the inflammatory 
symptoms have disappeared, a firm, hard, tendon-nodule 
or a diffuse thickening of the tendon. The lameness 
gradually disappears, it may, however, become chronie. When 
a tendon has once been diseased it is predisposed to relapse; 
this is especially true of race-horses, saddle-horses, and heavy 
draft-horses. Severe inflammations finally lead to adhesion 
between the tendon and the surrounding structures, as well as. 
to the formation of a tendon-contracture (tendon 
stilt-foot). | 

TREATMENT.—In addition to complete rest, very recent 
tendinitis characterized by severe pain and pronounced swelling 
can be treated with a cold compress, cold baths, or per- 
manent irrigation. In general it is better to immediately 
employ moist heat in the form of 4 Prieemane 
compress. Massage, and pressure bandage 
(silicate-of-potash bandage) are occasionally indicated. The 
methods employed are for the following object : resorption of 
the hemorrhagic extravasate and to support the natural pro- 
cess of healing, that is, the reactive, aseptic, inflammatory 
new-formation. It is also important to regulate the shoeing. 
The toe-calk is removed and excessive length of toe is short- 
ened, this removes strain from the flexor tendons and is of 
special importance in inflammation of the flexor perforans, the 
heels may be raised by adding heel-calks. 

If the methods described are not followed by healing or 
improvement after three or four weeks, especially when com- 
bined with methodical massage, counter-irritants are 
indicated. The variety and form of the remedy employed is 
non-essential, the manner of application of the blistering oint- 
ment or plaster is, however, of great importance. After having 
thoroughly tested the following method of application, which 
I learned in the Imperial Stables in Vienna, I can highly 
recommend it: The hair is clipped previous to the application, 
the skin is also thoroughly washed and disinfected, then apply 
biniodid of mercury ointment (1:4-5), this is rubbed in 
thoroughly for fifteen minutes, covered with an ordti- 


TENDON-RUPTURE 207 


nary bandage over absorbent cotton, and allowed 
to remain in position for two weeks. After twenty-four hours 
the bandage becomes moistened with an extensive exudate 
which soon dries; the horse’s head is tied up for the first few 
days. 

By employing the method described the application of the 
cautery for chronic tendinitis becomes unnecessary, the 
cautery may be employed in the form of line-firing. The 
action of the cautery is like that of blisters; it causes an arti- 
ficial acute inflammation of the skin and the subcutaneous 
parts; the blood-vessels are dilated ; the white blood-corpus- 
cles pass out of the blood-stream and become phagocytic; the 
solid masses of exudate are liquefied (peptonized) and resorbed 
(histolysis), this is due to the formation of ferments from the 
degenerating white blood-corpuscles. 

If hard, painless, nodular thickenings remain in the ten- 
don after the course of a chronic inflammation they cannot 
be removed any more than other cicatricial formations. 
Tenotomy may be successfully employed to counteract 
retraction of the tendon: | 

The suppurative and necrotic forms of tendinitis must be 
treated with incision, antiseptic irrigation, and 
eventually with resection. 


STATISTICS OF TENDINITIS.—Tendinitis is the most frequent form 
of disease of the tendons, it is one of the most frequent surgical affec- 
tions inthe horse. In the years 1886-1895, 36,230 horses were treated 
in the Prussian Army for inflammation of the tendons and tendon- 
sheaths. The affection most often involved both the perforans and 
the perforatus of one limb (70 per cent); then followed the suspensory 
ligament with 20 per cent. The right anterior limb was most often 
affected (43 per cent), then followed the left anterior limb (36 per cent) 
(Bartke).—Inflammation of the tendons is far less commonin dogs. 
Among 70,000 diseased dogs (1886-1895) I have observed only twenty- 
three cases of tendinitis; the achilles tendon was most frequently 
affected. 


20) THNDON—RUPTURE: 


CausEs.—I ncomplete tendon-rupture (partial, fibril- 
lar, fascicular) was described under inflammation of tendons. 


\ 


268 TENDON—-RUPTURE 


Complete (total) tendon-rupture forms another, independ- 
ent, affection. In contrast to open wounds and incisions of | 
tendons (tendon-wounds), ruptures are usually subcutaneous. 
The causes are usually external and, like traumatic tendinitis, 
are ordinarily due to overexertion and overstretching. They 
are less frequently caused by contusions. Asin tendinitis, in- 
ternal predisposing factors are common (so-called spon- 
taneous tendon-ruptures); these may be due to suppurative 
inflammation, necrosis, previous infectious diseases (contagious 
pleuropneumonia, petechial fever), and other derangements in 
the nourishment (osteomalacia, neurotomy) which cause a, 
loss of resistance. The following conditions especially predis- 
pose to tendon-rupture :suppurative tendovaginitis at the 
fetlock- and tarsal-joints, phlegmon of the fatty frog (nail 
pricks), and bursitis podotrochlearis. It is especially liable 
to occur as a result of prolonged standing on three limbs, the 
well foot becomes affected with painful pressure laminitis, so 
that the horse is obliged to again bear weight on the diseased 
foot. In many cases it is not possible to determine the cause 
of tendon-rupture (simultaneous rupture in several limbs). 

OccURRENCE.—In horses the following tendons are most 
often ruptured: flexor metatarsi, flexor perforame 
flexor perforatus, and suspeénsory liga 
in cattle and dogs the achilles tendon and flexor meta- 
tarsi are most often involved. In general, total rupture of the 
tendon is less common than other tendinous affections. For 
example, in the Prussian Army in the years 1889-1895, thirty 
thousand horses were affected with inflammation of the tendons 
and tendon-sheaths ; during the same time there were about 
three hundred cases of tendon-rupture. One case of total 
tendon-rupture occurs to a hundred of tendinitis and tendo- 
vaginitis. As arule only one tendon is ruptured; in race- 
horses and in spontaneous ruptures one finds, however, two or 
three, and even all four limbs simultaneously involved. For 
the process of healing see page 71. 

Symptroms.—The symptoms of tendon-rupture are vari- 
able, they depend on the tendon affected. 

a) Rupture of the flexor metatarsi occuremam 


TENDON-RUPTURE 269 


horses, occasionally in cattle, after over-stretching of the ten- 
don from excessive extension of the tarsal-joint (kicks, slips). 
It is characterized bya dangling movement of the 
lower part of the hind limb which comes on sud- 
denly, and a peculiar lameness in which the tarsal-joint 
is abnormally extended. Loss of resistance in the 
flexor metatarsi is easily recognized when the limb is raised in 
a position for shoeing, carrying the limb backwards results in 
tripping, at the same time the achilles tendon appears relaxed 
and lies in folds. Apparently the prognosis is favorable, 
healing without treatment usually takes. place in one or two 
months. 

b) Rupture of the flexor perforans and sus-. 
pensory ligament isobserved as follows : on the anterior 
limbs of race-horses, as well as during the course of a chronic 
inflammation of the pedal-joint, as a result of phlegmonous 
processes in the tendon-sheaths and the fatty frog. It is 
characterized by a lameness which develops rapidly with 
abnormal dorsal flexion of the fetlock-joint; on 
palpation one may locatea depression in the tendon at 
the point of rupture. In rupture of the flexor perforans the 
toe is raised. Ruptures of the flexor perforans and sus- 
pensory ligament in the region of the metacarpus usually 
require two or three months to heal; ruptures which result 
from necrosis are, however, nearly alwaysincurable. ‘Treat- 
ment consists in the application of a plaster-of-Paris bandage. 

c) Rupture of the achilles tendon is frequently 
observed in cattle. It is due to abnormal flexion of the tarsal- 
joint and excessive stretching of the tendon by means of falls, 
slips, and jumps, or to severe contraction of the gastrochnemius 
during extension of the joint. It is characterized by a 
severe lameness which develops suddenly, excessive 
mexiton of the lower part of the limb, knuck- 
ling, and inability to support weight ; the achilles tendon is 
thereby relaxed so thata space may be recognized at the 
point of rupture. In dogs the prognosis is relatively good 
(plaster-of-Paris bandage, tendon-sutures), in cattle and horses 
it is unfavorable (slings). Those cases in which the tendon 


270 NECROSIS OF TENDONS 


pulls away the periosteum and particles of bone from the point 


of the os calcis are usually incurable. 

TENDON-LUXATION. This is occasionally observed in the horse at 
the expansion of the perforatus where it passes over the os calcis. The 
dislocation may be either to the external or the internal side. The 
gliding movements of the dislocated tendon may be seen at the os calcis 
with every extension. Atthe same time one observes local swelling 
and an uncertain stumbling gait. The prognosis is grave, as a rule the 
luxation is incurable. 


3. NECROSIS OF TENDONS. 


CausEs.—Necrosis of tendons is due to a previous sup- 
purative tendinitis, which usually results from extension of 
phlegmonous processes from adjacent structures to the tendons. 
As the genuine tendon-tissue is not a vascular structure 
necrosis may easily occur and extend very rapidly. Necrosis 
is most frequently observed in the perforans tendon at the 
navicular bone, due to phlegmon of the fatty frog resulting 
from nail-punctures. The suppurative process in the frog 
extends to the bursa podotrochlearis, or, in perforating wounds, 
it may originate in this bursa and develop into a suppurative 
bursitis enveloping the perforans tendon in a sac of pus, which 
results in its rapid necrosis. Necrosis of the sus 
pensory ligament of the bulbs and t he emai 
cular bone, as wellas the ligament which pasees 
from the lateral cartilage to the first phatlagm 
often results from a suppurative stone-bruise in the angle of 


the sole. As these ligaments unite the perforans tendon to the 


fatty frog, and the bulbs to the lateral cartilage, they fre- 
quently convey the necrotic inflammation from one of these 
structures to the other. (Com.: Pfeiffer, Monatshefte 
fur praktische Tierheilkunde. 1897). 

Symproms.—The necrosed particles of tendon present a 
green, greenish-yellow, or yellow appearance. 
They appear to slough away rapidly from the sound tendon, 
so that the smooth, soft, relaxed, greenish-colored membran- 
ous structures may be removed from the cavity. Experience 
has demonstrated that tendon-necrosis may seemingly develop 


} 


eas aa 


NECROSIS OF TENDONS 271 


very rapidly. I have seen diffuse, green necrosis of the flexor 
tendon develop within a week after the nail-puncture. The 
other symptoms of necrosis of the flexor perforans are like 
those of phlegmon of the fatty frog and suppurative bursitis ; 
namely, severe supporting-leg lameness in which 
the diseased foot bears either little or no weight, pronounced 
wolar flexion, marked swelling in the frog and 
elett between the balls, pronounced. pain,on 
dorsal flexion of the hoof, as wellasa general 
mepadle, Condition, 

TREATMENT.—Treatment of tendon-necrosis is entirely 
operative. It consists ina free exposure of the tendon and 
removal of the necrotic particles. When a nail-puncture is 
followed by the previously described symptoms an early opera- 
tion renders the prognosis more favorable. The frequency 
of incurable tendon-necrosis following nail- 
mumctures is largely referable to delay in the 
Operative treatment. The operation may be per- 
formed in various ways. I employ the following technique : 
removal of the frog and fatty frog as far as the tendon by 
means of a three-cornered incision ; cut out that portion of the 
perforans tendon which lies between the superior border of the 
navicular bone and its pedal attachment ; carefully curette the 
walls of the bursa, especially that which covers the navicular 
bone, and remove all necrotic particles that may be attached to 
it; thoroughly irrigate the funnel-shaped operative wound, 
and provide drainage by means of an incision in the vicinity of 
the bulbs; pack with a loose tampon of iodoform gauze, and 
bandage the entire hoof. When this operation is employed 
early and the entire terminal portion of the necrotic tendon re- 
moved, healing usually occurs in one to two months if the 
pedal-joint is not involved. 


272 INFLAMMATION OF TENDON-SHEATHS 
II. DISEASES OF TENDON SHEATHS. 


I. INFLAMMATION OF THE TENDON-SHEATHS. 


TENDOVAGINITIS. 


Forms.—Inflammation of the tendon-sheaths 
(tendovaginitis, tendosynovitis, tendinous 
bursitis, tenalgia) occurs, similar to inflammation of 
the joints, in various forms. One distinguishes here, also, 
traumatic (non-bacterial, non-infectious, aseptic), inf ec- 
tious (septic, bacterial), and rheumatic inflammation 
of the tendon-sheaths ; one further distinguishesa primary 
anda secondary form (symptomatic, metastatic), 
acute and chronic, tubercular, etc. The various 
anatomical characteristics of tendovaginitis are of importance. 
The tendon-sheaths are covered on their inner surfaces with a 
layer of endothelium which is identical in structure with that 
lining the synovial membranes of joints, they are also covered 
with a serous membrane analogous to the pleura and peri- 
toneum. One distinguishes here, then, the following types of 
tendovaginitis: serous, serofibrinous, fibrinous 
(croupous, catarrhal, crepitating), suppurative, icho- 
rous, and chronic fibrous. From a practical surgical 
standpoint it is important to distinguish between the following : 
acute serous and acute suppurative, as well as tuberculous. 

SEROUS ‘TENDOVAGINITIS.—The causes are to be 
found, either in external mechanical influences (overexer- 
tions, contusions), or in internal infectious diseases (contagious 
pleuropneumonia, septicemia, articular rheumatism, contagious 
abortion), or cold (rheumatism of the tendon-sheaths). Pri- 
mary, traumatic tendovaginitis usually affects only one tendon- 
sheath; the secondary, symptomatic or metastatic inflamma- 
' tions, usually attack several sheaths at the same time. 

The symptoms consist in lameness, high temperature, 
more or less pain, and a soft, either fluctuating (T. serosa) or 
crepitating (T. serofibrinosa) swelling in the vicinity 
of the diseased tendon-sheath. If the exudate is 
not resorbed there develops, either a chronic hydrops 


INFLAMMATION OF TENDON-SHEATHS 273 


(tendon-sheath gall), or a chronic connective-tissue 
new-formation with pronounced thickening and schlerosis of 
the walls (tendovaginitis chronica fibrosa, in- 
durated tendon-sheath galls). In general the course of simple 
traumatic forms of tendovaginitis is more favorable than the 
symptomatic ; this is especially true of inflammations of sheaths 
that occur during the course of contagious pleuropneumonia, 
which are often chronic and remittent in character. T’endo- 
vaginitis of the extensor tendons is more favorable than that of 
the flexors. 

The treatment of serous or serofibrinous tendovagi- 
nitis consists in the application of moist warmth in the form of 
Priesnitz compress, as well as massage, further, in the 
application of a pressure bandage and absolute rest for the 
ea COold. operative treatment, and firing 
are contra-indicated. When the resorption is de- 
layed and there is a tendency for the process to become 
chronic, a stimulating application or iodine may be applied. 

* SUPPURATIVE TENDOVAGINITIS.—This follows open- 
injuriesto the tendon-sheaths; it is the result of the en- 
trance of pus-bacteria from without (punctured wounds at the 
tarsal-joint) ; it may also be due to the extension ofa 
suppurative phlegmonous process from neigh- 
boring structures to the tendon-sheaths (fatty frog) ; finally, 
it may have a hematogenous origin in pyemia and 
strangles. 

It is characterized by the following symptoms: a 
Miemreomonous swelling which is very exten- 
Sive, spreads rapidly, is painful, and is occasionally 
accompanied by abscess formation. The animal is very 
lame and often has a high fever. It frequently leads to 
necrosis and rupture of tendons; to opening of neigh- 
boring joints with a subsequent ichorous and suppurative ' 
arthritis, especially in the knee-joint (the tendon-sheath of the 
extensor pedis communicates with the joint-capsule), the 
tarsal-joint, the fetlock-joint, and the pedal-joint; as well 
Memomseptic and pyemic generalsvinfection. 
Occasionally the course is very chronic, several months; the 


274 INFLAMMATION OF TENDON-SHEATHS 


condition is alternately improved and aggravated for a period 
of several weeks, relapses are common after the disease has 
apparently been cured. 

Treatment consists in the application of antisep- 
tics. In the early stages one opposes the inflammatory pro- 
cesses by means of antiseptic bandages, baths, and applications 
(iodoform gauze, camphor ointment, spirits-of-camphor 
bandage, grey mercurial ointment). This method of 
treatment, however, must not be continued 
too long. Whenit is once demonstrated that there is pus 
in the tendon-sheath or that the tendon is affected with 
necrosis, an operation must be performed immediately. This 
consists in incision, antisepticirrigation, drain- 
age, resection of the necrotic particles of tendon, and 
the application of an antiseptic tampon covered with 
an aseptic bandage. Insuch cases one does not 
hesitate to open the sheaths of “flexommar 
dons of the horse. The only rational method of treat- 
ment consists in an early free incision and a thorough disin- 
fection of the suppurative tendon-sheath, with removal of the 
pus and necrotic particles of tissue. 

TUBERCULAR ‘TENDOVAGINITIS. According to Hess 
and Guillebeau this is very common in cattle, it is partly 
a primary affection, partly secondary to generalized tubercu- 
losis. The tendon-sheath of the extensor metacarpi 
(M. extensor carpi radialis) on the anterior surface of the 
carpus is most frequently affected, it may be unilateral or 
bilateral. Along the course of the named tendon-sheath, oc- 
casionally along the entire length of the forearm, there exists 
a diffuse, hot, firm, painful swelling; it may be as large as a 
man’s arm, at times crepitation is present (tendovaginitis 
fibrinosa). It is characterized by severe lameness, rapid mus- 
cular atrophy at the shoulder, and general emaciation. The 
animal is usually slaughtered as the condition is seldom cur- 
able ; the tendon-sheath presents marked thickenings, is hyper- 
emic and covered with fibrin, occasionally it contains numer- 
ous corpora oryzoidea (hygroma proliferum). Inoculation of 
guinea-pigs with the exudate produces tuberculosis. 


HYDROPS OF TENDON-SHEATHS 275 


A similar tubercular tendovaginitis occurs in cattle in the 
superior tendon sheath of the long extensor of the toe 
(M. extensor digitorum pedis longus); occasionally the disease 
is simultaneous with that of tuberculosis of the knee-joint 
(communication). 


2. TENDON-SHEATH GALLS. HYDROPS OR HYGROMA 
OF THE TENDON-SHEATHS. 


CausEsS.—A tendon-sheath gallis acondition 
characterized by the accumulation ofa serous 
fluid in the tendon-sheaths, the walls of the 
sheath are dilated and are usually thickened, 
pain and other inflammatory symptoms are 
absent, itis termed achronic hydrops or hygroma 
of the tendon-sheaths. It usually develops froma chronic, 
repeated, serous tendovaginitis resulting from severe exertions, 
it is, therefore, more common in old horses than in young. 
The inflammatory irritant is found in the mechanical rubbing 
of the tendon on the walls of the tendon-sheath ; the process 
is aseptic; that is, it develops without the influence of 
bacteria. “Tendon-sheath galls as a result of contagious 
pleuropneumonia are less frequent (among 1400 horses 
affected with pleuropneumonia in the Prussian Army in 1895 
only five cases were observed). 

OCCURRENCE.—Hygromata of the tendon-sheaths are 
most often observed in horses and draft-oxen. They are 
usually classified as hygromata of the flexor ten- 
don-sheaths and hygromata of the extensor ten- 
don-sheaths; the former, because of their size, frequency, 
and difficulty in healing, are more important than the latter. 

a) The most important flexor tendon-sheath 
hygromata in the horse are on the anterior limbs. The 
flexor tendon-sheath hygromata at the pos- 
terior surface of the carpus (the common tendon- 
sheath of the flexor perforatus and perforans at the posterior 
border of the carpal-joint, the hygroma originates about ten 
centimeters above the joint and forms a long swelling which 


So 
poe 


276 HYGROMATA OF TENDON-SHEATHS 


terminates at the second third of the metacarpus). The 
flexor tendon-sheath hygromata at the pos- 
terior surface of the fetlock, or windgalls (inferior 
tendon-sheath of the perforatus and perforans, the hygroma 
forms two long swellings placed at the sides of the tendon of 
the flexor perforans, behind the metacarpus and above the 
fetlock-joint). On the posterior limbs, in addition to those 
mentioned above, which are frequently indurated in the region 
of the fetlock; there exist hygromata of the flexor 
tendons _in the region of the tarsaleyoame 
(tendon-sheath of the flexor perforans on the postero-internal 
surface of the tarsal-joint, swelling as large as a child’s head on 
the inner surface, as large asa hen’s egg on the posterior sur- 
face—curb). Also at the summit of the os calcis (tendon- 
sheath of the flexor perforatus where it passes over the achilles 
tendon, it originates twenty centimeters above the summit of 
the os calcis and forms two long swellings on the tnner and 
outer sides of the achilles tendon, it terminates just above the 
summit of the os calcis). 

b) The most important extensor tendon hygro- 
mata of the anterior limbs are, first, those on the anterior 
surface of the carpal-joint, four so-called carpal 
tendon-sheath galls. They are arranged as follows from the 
lateral to the medial surface: 1. Hygromaof the sheath of 
the extensor suffraginis (M. extensor digiti minimi), 
a swelling about the size of a goose-egg which begins at the 
side and above the carpal-joint ; 2, distention of the tendon- 
sheath of the extensor pedis (M. extensor digitorum 
communis), a swelling that extends from the lower end of the 
radius over the anterior surface of the carpal-joint, to the 
upper end of the metacarpus; 3, hygroma of the sheath of 
the extensor metacarpi (M. extensor carpi radialis) 
in the middle of the anterior surface; 4, distension of the 
sheath of the oblique extensor of the cagmam 
(M. abductor pollicus longus), -a swelling which passes ob- 
liquely downwards and inwards from the supero-external 
region of the carpus. On the anterior limbs there also occur 
hygromata of the extensor tendons at the fetlock (mucous 


a 


HYGROMATA OF TENDON-SHEATHS 277 


bursa, or tendon-sheath of the long extensor of the toe on the 
anterior surface immediately over the fetlock-joint ; swelling 
the size of a goose-egg). On the posterior limbs, in addition to 
those already mentioned around the extensors of the fetlock, the 
sheath of the peroneus tendon at the tarsus 
may also become distended. It forms a hydrops about the size 
of a walnut on the infero-lateral surface of the tarsal-joint. 
Finally, although uncommon and seldom large, there occurs 
an extensor tendon-sheath hygroma on the 
anterior surface of the tarsal-joint, that is, a 
tendon-sheath hygroma of the extensor pedis in the 
middle of the anterior surface of the tarsal-joint. 

The walls of these hygromata occasionally undergo pro- 
nounced thickening, this is especially true of those on the hind 
limbs (tendovaginitis chronica fibrosa). Corpora oryzoidea 
are occasionally observed within the distension (hygroma 
proliferum ). 

TREATMENT.—Hygromata of the tendon-sheaths are 
usuallyincurable. Ordinarily they are not accompanied 
by lameness and are of little importance (blemishes). In 
cheap horses their removal should not be considered. Opera- 
tive treatment, on the other hand, which is the only method 
whereby results may be obtained, is not without danger be- 
cause of the difficulty of applying an aseptic bandage. For 
this reason treatment is not usually adopted. 

When it is decided to employ operative treatment 
for tendon-sheath hygromata, the only rational method is to 
make free incisions, irrigate with antiseptics, 
curette or extirpate the thick, fibrous wall, provide 
drainage for the tendon-sheath and apply an aseptic 
bandage. The object of the operation is to obliterate the 
tendon-sheath by producing adhesions between the walls of 
the sheath, and healing per prima of the incised wound. The 
danger lies in the difficulty of obtaining asepsis ; infection may 
lead to suppurative and ichorous tendovaginitis with a conse- 
cutive septicemia and pyemia. However, the operation has 
been successfully performed several times. Puncture of 
the hygroma with a subsequent injection of an aqueous 


278 DISEASES OF MUCOUS BURSAE 


solutiou of iodid of potash (1:100-200) isa safer 
operation, but the results are less certain. Regardless of a 
few successful cases, puncture with the cautery 
cannot be regarded as a safe operation. Inchronic hygromata 
ordinary point and line-firing, as well as applications of blis- 
tering ointments or plasters, produce no results. 


III. DISEASES OF MUCOUS BURSAE, 
I. INFLAMMATION OF MUCOUS BURSAE. BURSITIS. 


Forms.—Diseases of the mucous bursz may be classified 
like those of the tendon-sheaths and joints, namely, serous, 
fibrinous, suppurative and hemorrha gicusluew 
may be further designated as traumatic and infectious, 
acute and chronic, as well as tuberculous and 
botryomycotic. According to the seat of the mucous 
bursa, one further speaks of a bursitis podotrochlearis, 
intertubercularis, trocaniterica, prepates 
laris, olecrani, calcanei, and intraspiieieas 
It is of special practical importance to distinguish between am 
acute serous or sero-fibrinous, and an acute suppurative 
bursitis. 

SEROUS BursiT1s.—The causes of acute serous in- 
flammations (acute hygromata) of the mucous burse are 
usually traumatic. They consist in contusion of the 
bursa by means of pressure, blows, or kicks, with a subsequent. 
extravasate of blood (bursal hematoma) and a circumscribed 
inflammation. For example, bursitis olecrani in the horse is. 
due to pressure on the elbow from the heel-calks when the 
animal lies with the limbs folded under the body (shoe-boil). 
Bursitis calcanei is due to contusions of the bursa over the os. 
calcis, dueto kicking. It has not yet been clearly demonstrated 
whether metastatic bursitis occurs, as in inflammation of the 
tendon-sheaths. It is claimed that bursitis podotrochlearis. 
may have a metastatic origin during the course of contagious. 
pleuropneumonia, and that supra-atloid bursitis may result in 
the same way from strangles (so-called poll-evil). 


SUPPURATIVE BURSITIS 279 


The symptoms of traumatic bursitis are as follows : 
swelling which usually develops rapidly (over night), 
local pain and heat ; the consistency of the swelling is variable 
(semi-solid, fluctuating, crepitating). The contused skin may 
be partially involved. If resorption does not occur during the 
course of three or four weeks, there develops a chronic, 
hyperplastic inflammatory process in the walls of the bursa 
(chronic hygroma of the bursa). 

Treatment of acute serous bursitis consists in mas- 
sage, Priesnitz compress, application of iodoform-collo- 
dion, as well as thoroughly applied ointments of iodoform, 
camphor, or mercury. Incision is contraindicated. 
It leads to the danger of a suppurative bursitis as an occlusive 
bandage is difficult to apply. 

SUPPURATIVE BuRSITIS.—This is observed in contusions 
that are accompanied by an injury to the skin'and combined 
with an opening into the bursa; it also results from incisions 
in serous bursitis. It is characterized by an extensive phleg- 
monous swelling, aswellasa purulent discharge. 
It often responds very slowly to treatment which consists 
in antiseptic irrigation, and drainage, as well as operative 
extirpation of the infiltrated purulent bursa. 

TUBERCULAR BuRsITIS.—The subcutaneous bursa on the 
anterior surface of the carpus in cattle is occasionally the 
seat of a tuberculous inflammation (bursitis fibrinosa). The 
mucous bursa is transformed into a sac as large as the head of 
a child ; from this a form of carpal tumor, a tuberculous 
hygroma, may develop (Hess, Guillebeau). 


BURSITIS PODOTROCHLEARIS.—This is a chronic inflammation 
Gernwestendon-sheath of the flexor perforans in the 
vicinity of the navicular bone, and just above the attach- 
ment of the tendon to the os pedis. It is also known as podotroch- 
Dytts,* inflammation of the pulley of the foot, chronic 
lameness of the pedal-joint, or navicular disease. It 
is especially common in narrow anterior feet of high-spirited horses. 
The bursa just beneath the navicular bone is exposed to continual strain 
and contusion from the descent of the bone; this leads to a bursitis 


1The term ‘‘podotrochlitis’’ employed by Brauell and extensively used since 
that time is a false expression ; it should be called podotrochiliitis, ‘‘Podotrochlitis”’ 
is a better sounding term (Cf. bursa podotrochlearis). 


280 HYGROMATA OF MUCOUS BURSAE 


which develops very slowly with symptons of a chronic arthritis 
deformans (ulceration and erosion of the cartilage of the inferior 
surface of the navicular bone, with granular and rarefying ostitis and 
even fracture of the navicular bone, thickening of the bursa, fibrillation 
and laceration of the perforans tendon). The disease results in a 
chronic, usually incurable lameness with contraction of the hoof. Asa 
rule neurectomy is the only method of overcoming the lameness. — 
There is also an acute suppurative bursitis podotrochlearis due 
to nail punctures. 


2. HYGROMATA OF MUCOUS BURSAE (CHRONIC HYDROPS). 


OcCURRENCE.—Hygromata of mucous burs usually de- 
velop from a chronic bursitis through the continual 
influence of traumatic injuries; for example, the forma- 
tion of so-called tumors of the elbow in the horse from lying 
on ahard surface with the anterior limbs folded under the 
body, or from contusions of the bursa olecrani when the animal 
is rising, or the so-called carpal tumors in cattle (contusion of 
the bursa precarpalis when the animal is rising or lying down). 
In cattle, a few hygromata are of tubercular origin, espe- 
cially onthe carpus. ‘Tumor-like processes (cysts) appear to be 
typical of many bursal hygromata. Like the fibrous hygromata 
of the tendon-sheaths, chronic fibrous bursitis of the mucous 
membrane may result in thickening and induration, even cal- 
cification of the walls (capsule formation), as well as the 
production of corpora oryzoidea on the inner surface (hy- 
groma proliferum, ganglion creépitass gee 
neighboring connective tissue also, is involved in the forma- 
tion of the capsule in the form of a chronic peribursitis. The 
following are the most important bursal hygromata : 

a) Hygroma ofthe bursa olecrani, so-called shoe- 
boil, forms a circumscribed, round or oval swelling at the 
olecranon process. In the horse it is the size of a fist to that 
of one’s head ; in dogs from that of a hen’s egg to that of an 
apple. In contrast to acute bursitis, it is painless, usually of a 
firm, hard consistency, and the skin is more or less moveable 
on the surface. It frequently occurs on both elbows in horses 
and dogs without causing lameness. In well developed cases © 
it may be considered, not a bursitis, but a product of bursitis. 


HYGROMATA OF MUCOUS BURSAE 281 


b) Hygroma of the bursa calcanei, so-called 
capped-hock, forms a painless, circumscribed, roundish swell- 
ing at the seat of the subcutaneous bursa over the tuberosity 
of the oscalcis. It is about the size of an apple, elastic, and 
is not usually accompanied by lameness. This should be dif- 
ferentiated from other pathological changes in the same region 
that are also included under the term capped-hock ; namely, 
inflammation and hygroma of the tendon-sheath of the flexor 
perforatus (cap-like expansion), contused swellings of the skin 
and subcutem, as well as osteophytic formation on the 
calcaneum. 

c) Hygromata of the subcutaneous bursae over the 
tuberosities of the ischia, and over the occipital 
bone are especially common in puppies in the form of pain- 
less, circumscribed enlargements from the size of a dove’s egg 
to that of a goose-egg ; they are firm and smooth, and the skin 
is moveable on the surface. In cattle, also, one frequently ob- 
serves hygromata at the tuberosities of the ischia, occasionally 
they become very large (size of a head). In horses, hygromata 
of the same size are occasionally observed on both sides of the 
withers. 

d) In cattle there is frequently observed a subcutaneous 
hygroma on the anterior surface of the carpus (bursa pre- 
carpalis). It is in the form of a firm sac and may reach the 
size of a man’s head (carpal tumor), it is usually traumatic 
(rising) seldom tuberculous in origin. This form is not 
common in horses. 

TREATMENT.—Treatment, like that of hygromata of the 
tendon-sheaths, is seldom indicated in bursal hygromata 
as they rarely cause lameness or other functional derange- 
ments. Operative treatment of the so-called capped-hock is 
not entirely free from danger, especially when it is in the form 
of a hygroma of the subtendinous bursa of the flexor perfo- 
ratus. In all well-developed bursal hygromata 
Pimesapplication of blistering oistments and 
Mmemeters, as well:as the use of the cautery 
is of little influence. Mere puncture is rarely fol- 
lowed with favorable results. Better results, especially in the 


282 HYDROCELE 


treatment of shoe-boils, appear to have been attained by 
means of puncture, and injection of tincture of 
iodine, with a subsequent incision inthe skin and re- 
moval of the necrotic sac (Kallmann); this method has 
also been employed for carpal cysts in cattle (Zehl). Ifthe 
hygroma is entirely detached, it only requires operative 
removal, that is, complete extirpation of the cyst (not mere 
incision) with the knife. The operation, especially in capped- 
hocks and shoe-boils, usually requires a long period of after 
treatment. Continual movement and inability to apply an 
occlusive bandage prolong the process of wound healing. In 
the treatment of capped-hock the rapidity of healing is in- 
creased under the influence of a Bayer’s tension-suture, in 
certain cases it may heal by first intention. Operative treat- 
ment is frequently followed by the return of the hygroma 
as the cause is not removed. Small hygromata may be treated, 
as in man, by subcutaneous rupture. The long- 
employed ligature isapplicable only to pedunculated hygro- 
mata. The application of counter-irritants cannot be recom- 
mended. Whether the recently employed injection of pure 
cultures of staphylococcus pyogenes aureus with subsequent 
incision of the artificially developed abscess is of practical 
importance, remains to be demonstrated. 


HyDROCELE.—This term indicates a chronic hydrops of the 
vaginal sheath (processus vaginalis) in which the serous fluid 
either lies free in the cavity of the fibrous portion of the tunica vaginalis 
(hydrops ascites), or is found asa circumscribed swelling between the 
duplicatures of the tunica propria (hydrocele of the spermatic cord). 
The first form is common in stallions and is occasionally observed dur- 
ing the castration of these animals; itis the product of a serous peri- 
orchitis. The second form, on the other hand, while common in man, 
isseldom seenin animals. Treatment, when one wishes to avoid castra- 
tion, consists in the extirpation of the tunica propria. Disinfect, make 
a free incision in the tunica vaginalis and expose the spermatic cord, 
suture and apply an aseptic bandage. 


DISEASES OF MUSCLES 283. 
DISEASES OF MUSCLES, FASCIAE AND NERVES. 


I, DISEASES OF MUSCLES. 


PRELIMINARY REMARKS ON ANATOMY. 


MuSCLES.—Diseases of muscles, especially inflammations of these 
tissues, are confined, partly to the muscle-fibers, partly to the 
intra- and intermuscular connective tissue, the perimysium in- 
ternum and externum, as wellasthe fasciae and the subfascial 
spaces. The fasciae play an important part in the surgery of 
muscles. As the fascize have not been given sufficient appreciation in 
many anatomical text-books, the following description according to 
Hichbaum will be briefly considered: ‘‘(Die Faszien des Pferdes.’’ 
Berliner Archiv. 1888 und 1889). 

Fascie2.—Fascia or muscle-ligament is considered a form 
of aponeurosis. This firm connective-tissue membrane is interwoven 
with elastic fibers. Its function is to enclose or separate muscles or 
groups of muscles in a sheath-like manner. It consists largely of 
connective-tissue fibers with a few blood-vessels and nerves, this ac- 
counts for its tendency to necrosis. Interfascicular spaces are located 
between the fascize ; phlegmonous processes extend very easily and 
rapidly within these spaces. The fascize support the muscles in their 
activity by performing the functions of a physiological pump, they 
favor the circulatory movements of the blood and lymph during con- 
traction and relaxation of the muscles. Ruptures of fasciz result in the 
formation of muscle-hernias, and dislocation of muscles (biceps femoris 
in cattle). On account of their firmness they are not often affected 
with inflammation; occasionally they form a wall against outward or 
inward progression of an inflammation. On the other hand, they favor 
the extension of subfascial phlegmons. The question of the relation of 
contractures of the fasciz to the development of stringhalt is still 
open for accurate scientific demonstration. 

I. Fasct# OF THE HEAD AND NECK.—I!. The superficial 
fascia of the neck (F. superficialis colli) is in combination with 
the cutaneous muscle in the horse (aponeurotic portion of this muscle). 
It forms two lamellz, and extends from the ventral margin of the neck 
over the lateral surfaces, terminating on the dorsal margin (cervical 
ligament). A median septum passes downwards in the median line of 
the inferior cervical border. ; 

moines deen fascia of the neck (&. profunda coll) 
passes over the anterior and lateral surfaces of the trachea, and forms 
the capsule of the thyroid glands above, as well as the external surface 
of the guttural pouches. The jugular vein, surrounded by loose con- 
nective tissue, lies between the superficial and the deep cervical fascia. 
At the thoracic inlet this fascia covers the inferior tracheal glands. 


284 DISEASES OF MUSCLES 


3. Thefascia propria of the trachea encloses the trachea 
in the form of a sheath. 

4. The nuchal Fascia (F. nuche) borders posteriorly the 
subcutaneous cervical fascia, and is to be considered as a lateral continu- 
ation of the cordiform portion of the ligamentum nuche. It is located in 
the region above the shoulder, and is covered with the superficial cervical 
fascia. In the vicinity of the superior cervical border it is very thick 
and contains the so-called fatty crest. 

5. The fascia of the parotid and masseters (F. paro- 
tideo-masseterica) lies between the auricular, parotid, intermaxillary, 
facial and masseter surfaces. The pharyngeal fascia extends 
over the external surface of the pharyngeal muscles. 

6. Tenon’s fascia (Tenon’s capsule) originates on the corneal 
margin of the orbit, passes over the anterior portion of the schlera, and 
from there to the retractor bulbi, finally enclosing the optic nerve. 

II. Fascias OF THE TRUNK AND PELVIS.—1I. The superficial 
fascia (F. superficialis s, subcutanea) lies below the thoracic and 
abdominal panniculus carnosus, and becomes attached to the linea alba 
in the median line. Posteriorly it forms the basis of the knee-fold, as 
well as the superficial layer-of the fascia of the prepuce, covers the 
inguinal ring as well as the pudic glands, and encloses the testicles 
in the form of the muscular dartos. 

2. The dorsal fascia (dorso-lumbar fascia, F. lumbo-dorsalis ) 
is divided intoa superior, superficial layer, which covers the longissimus 
dorsi muscle, and an inferior, deep layer, which lies between the last 
rib and the anterior margin of the ilium. Between the superficial fascia 
(1) and the dorsal fascia there lies an interfascial space filled with loose 
connective tissue (of surgical importance with reference ‘to fistulous 
withers and saddle-pressure); similar spaces are located between the 
layers of the dorsal fascia, as well as between the superficial layer of the 
dorsal fascia and the longissimus. | 

3. The yellow abdominal tunic covers the external ob- 
lique muscle. A continuation of this goes to form the fascia of the penis, 
or the supporting ligament of the udder; in combination with the 
terminal aponeurosis (Poupart’s ligament) of the external oblique 
muscle it forms the inguinal fold and the crural membrane (lamina 
femoralis). 

4. Thelumbo-iliac fascia (F. iliacas. lumbo-iliaca) covers 
the inferior surface of the iliopsoas in the lumbar region and becomes 
continuous with the pelvic fascia. 

5. The transverse abdominal fascia (F. transversa s. 
transversalis abdominis) lies between the transverse abdominal muscle | 
and the peritoneum. The tunica vaginalis communis is a continuation 
of this fascia, 

6. The pelvic fascia (F. pelvis) covers over the inner surface 
of the walls of the pelvic cavity. | 


DISHASES OF MUSCLES 285 


7. The perineal fascia (F. perinei) is divided into a super- 
ficial layer (F. perinei superficialis), a continuation of the subcutaneous 
fascia of the hips, and a deep layer (F. perinei propria), a continuation 
of the fascia of the hip. 

III. Fascia OF THE ANTERIOR Limss. 1. The superficial 
fascia (F. superficialis) lies beneath the panniculus carnosus as far as 
the elbow-joint, it is thin and transparent and extends as far as the 
fetlock-joint. 

2. The scapulo-humeral fascia (F. brachii) lies beneath 
the preceding on the external surface of the scapulo-humeral region, 
and consists of a superficial and adeep layer; the first becomes con- 
tinuous with the superficial layer of the sheath of the biceps brachii. 

feeiue true or deep fascia ‘of the forearm, (PF. anti- 
brachii) passes, in the form of a firm band, over all the muscles of 
the forearm as well as the median surface of the radius. At the carpus 
itforms the deep carpal sheath (F. carpi profunda), on the volar 
surface of the carpus it forms the transverse ligament of the 
carpus, it terminates at the middle of the flexor tendons in’the form _ 
of a semilunar margin. It forms several intermuscular ligaments 
between the extensors and flexors of the forearm. 

4. The fasciae of the foot (F. plantaris) form broad or 
small ligaments which hold the tendons in position and strengthen the 
articular ligaments. 

IV. THE FAscia OF THE POSTERIOR LimBs.—The superficial 
fascia (F. superficialis) is formed from a continuation of the aponeuro- 
sis of the abdominal panniculus; it covers the muscles of the hip, the 
biceps and semitendinosus, as well as the sartorious, gracillis, and semi- 
membranosus as far as the region of the knee; it terminates at the 
coronet. 

2. The fascia of the hip (F. gluteii) lies beneath the pre- 
ceding, and is a continuation of the dorsal fascia, it covers the muscles 
of the hips and buttocks, and becomes continuous with the fascia lata 
at the femur. Passing downwards it is transformed into a fascia which 
encloses the muscles of the femur (tensor facia lata, biceps, semitendin- 
osus); passes the tibia, and may be traced as far as the tarsal-joint. It 
also forms numerous intermuscular septa between the muscles of the 

“hip and the femur. 

3. The femoral ligament or broad crural ligament 
(F, lata) is a continuation of the aponeurosis of the external oblique 
muscle on the inner surface of the limb, it fuses with a projection of the 
gluteal fascia on the anterior and posterior margins of the upper part of 
the limb. It forms a ring for the entire musculature of the femur. 

4. The tibial fascia (F. cruris) covers the muscles of the tibia 
in the form of a very strong aponeurosis, and extends downwards over 
the tarsal-joint and the metatarsus. It consists of a superficial (contin- 
uation of the crural fascia), and adeep layer (formed from the tendon 


286 INFLAMMATION OF QUSCLES 


of the biceps, semimembranosus, semitendinosus and gracillis), as well 
as the common sheath of the tibial muscles. The last named muscle- 
sheath encloses the muscles and is in immediate contact with them, it 
is divided into three parts: 1. The muscle-sheath for the flexor 
metatarsi, anterior tibial muscle and long extensor of the toe; 2. 
The tendon-sheath for the flexor perforans and popliteal muscle; 
_3. The tendon-sheath for the lateral extensor of the toe. 


I. INFLAMMATION OF MUSCLES. MYOSITIS. 


Forms.—According to causes, the following forms are 
recognized: traumatic’ (contusions), 1h eames 
(cold, muscular rheumatism), infectious (bacteria), and 
parasitic myositis (sarcosporidia, trachina). ‘The follow- 
ing specific infectious and parasitic (fyamem 
of myositis are also recognized: actinomyc¢otuce 
botryomycotic, sarcosporidic, trichinous, 
tubercular, and glandular myositis.. According 

‘to the course one distinguishes an acute anda chronic; 
according to the character of the inflammation, a serous, 
suppurative, interstitial of fib10OUS, (gee 
chymatous, and ossifying myositis. Finally, inflam- 
mation of muscle may be classified as primary and secondary 
(symptomatic, metastatic). The latter is observed during the 
course of pyemia, strangles, tuberculosis, etc. The following 
are of practical importance : 

a) Traumatic myositis. 

b) Muscular rheumatism. 

c) Parenchymatous myositis. 

d) Suppurative myositis. 

e) Interstitial myositis. 

f) Ossifying myositis. 

TRAUMATIC MyosiITISs.—This most often occurs in horses 
as a result of contusions and exists in the form of an aseptic 
inflammation, it may also result from overextension, strain, or 
partial rupture of muscles. It is partly hemorrhagic, partly 

‘serous (myositis hemorrhagica and serosa). It 
is especially observed in the region of the shoulder as a result 
-of blows and collisions. It is a cause of one form of so- 
called shoulder lameness which is characterized by well 


INFLAMMATION OF MUSCLES 287 
“a ; 


pronounced hanging-leg lameness and dragging of the limb; 
it is usually due to an inflammation of the lower end of the 
mastoideo humeralis or the biceps muscle. Local examination 
reveals a circumscribed areaof pain, swelling, as well 
as increased heat inthe parton palpation. In contrast to 
rheumatic myositis, the area of pain has a definite local bound- 
ary, and is not wandering ; ordinarily the anamnesis furnishes 
evidence of the traumatic origin. ‘Traumatic myositis is also 
observed on transports asa result of improper treatment 
and narrow stalls, especially in cattle and swine in the follow- 
ing places: muscles of the shoulder, thorax, and gluteal 
regions. When the animals are slaughtered the following 
conditions are observed: serous and hemorrhagic, gelatinous 
infiltration of the internal and external perimysium, softening, 
discoloration, and degeneration of the muscular bundles, as 
well as loss of transverse striations, and other degenerative 
changes in the muscular fibers. Traumatic myositis usually 
runs an acute course; this is especially observed in those 
cases of shoulder lameness in the horse due to muscular con- 
tusions. In many, resorption is rapid and recovery is complete 
ina few days. In other cases there is a connective-tissue 
development between the muscle-fibers at the seat of the con- 
tusion as the result of a chronic aseptic inflammation (inter- 
stitial myositis ; schlerosisof muscles). Treatment consists 
in rest and massage, as well asin the application of moist 
warmth in the form of Priesnitz compress. 

MuscULAR RHEUMATISM.—Rheumatic myositis due to 
cold is most often observed in horses, dogs and cattle. The 
anatomical changes are as follows: hyperemia, serous 
and small-celled infiltration of the perimysium internum 
(polymyositis serosa), softening, discoloration and de- 
generation of the muscle-fibers (cloudy swelling, and fatty 
degeneration) ; multiple hemorrhagic foci are less common 
(polymyositis hemorrhagica). When the disease runs 
a chronic course, rheumatic muscular cicatrices form as a re- 
sult of new formations of connective tissue (interstitial 
myositis) and atrophy of the genuine muscle substance. 
The symptoms, consist of lameness which develops 


288 INFLAMMATION OF MUSCLES 


we 


suddenly after a previous cooling (rheumatic shoulder lameness, 

rheumatism of the shoulder, omodynia, rheumatic sacral lame- 
uess, lumbago), oblique position ofthe neck (torticolis), 

occasionally dyspnea (pleurodynia). Shoulder lameness may 
be caused by a myositis of the mastoideo humeralis, lameness 
in the sacral region by myositis of the psoas muscles. ‘These 
muscles are painful on palpation, this is especially true of 
the psoas muscles in lumbago of the dog., Hemoglobinuria 
(lumbago, azoturia) of the horse is considered a rheumatic 
myositis of the lumbar muscles, in contrast to traumatic myositis 
the rheumatic form is often wandering and recurrent; 

it often temporarily disappears entirely when the animal is. 
moved for some time. It also has a much greater tendency to 
run a chronic course. Treatment consists in the external 
application of moist warmth, massage and stimulating appli- 

cations (spirits of camphor), as well as the internal adminis- 
tration of salicylic preparations (horses 100 grams, dogs 2 to 
8 grams, of salicylate of soda per day), antifebrin or antipyrin. 

In very obstinate cases of rheumatic shoulder lameness in the 

horse one may also employ subcutaneous injections of veratrin 
(0.05 grams veratrin in 5.0 grams spiritus). Very painful 
omodynia in the horse, and lumbago in the dog, are often 

rapidly improved by subcutaneous injections of morphine 
(0.02-0.05 grams). The combined application of atropin and 
morphine in shoulder lameness of the horse, on the other hand, 

is not safe (fatal colic). 

PARENCHYMATOUS MyosITIS.—As a result of excessive 
muscular exertion, and pronounced exhaustion of the muscu- 
lature of the body, especially from overheating asa result 
of riding for along distance, running ome 
track (‘“‘race-track disease’’), after standing for a long time 
in the cars (‘“‘shipping-disease’’ of cattle), after tying 
horses high in the stall fora long time, after driving cattle 
long distances, after casting, as well asa result of severe at- 
tacks of hemoglobinemia (azoturia), there develops in 
horses, occasionally also in cattle, an acute, parenchy- 
matous degeneration of muscles, with symptoms 
of parenchymatous myositis. The following groups of muscles 


INFLAMMATION OF MUSCLES 289 


are most often affected: the dorsal and gluteal muscles, those 
of the psoas group, the quadriceps and the anconeus. On ex- 
ternal examination of these muscles, especially the longissimus 
dorsi and the glutei, one finds in the early stages, a hard 
swelling and severe pain on palpation, the back is 
carried stiffly; occasionally one also observes symptoms 
Seemovec, shemorlobintria, and high fever, 
According to the degree of extension and localization of the 
muscular degeneration one further observes, eithera general 
or sacral paralysis (sacral weakness), or a paralysis 
confined to the extensors of the knee and elbow 
(falsely so-called crural and radial paralysis) ; it may be uni- 
lateral or bilateral. The macroscopic anatomical changes 
are as follows: pale, light-grey color of the muscle, occasion- 
ally it is colored like the flesh of fish, is abnormally friable, 
and has a cooked appearance. Intramuscular hemorrhage and 
rupture are sometimes observed. Microscopically, in addition 
to the symptoms of secondary inflammation, various forms of 
muscular degeneration are seen: cloudy swelling (al- 
bumenoid), fatty, hyaline or amyloid degenera- 
tion. Theterminationis variable. At timesthe 
animal dies suddenly as a result of general paralysis. In 
other cases degenerative atrophy of the involved 
muscles may occur, it is partly chronic, partly acute and is 
characterized by symptoms of paralysis and weakness. 
Treatment consists in the use of slings, massage, and elec- 
tricity, as well as subcutaneous injections of caffein and 
camphor. 


Since the year 1896 when I first referred to the parenchyma- 
tous form of myositis, which results from overheating, and 
casting of horses, and called attention to the relation between 
thisand hemoglobinuria, many similar cases have been observed 
in horses and cattle. A horse that was thrown for neurectomy 
became very uneasy, on the following day there developed symptoms of 
hemoglobinemia. The post mortem revealed parenchymatous poly- 
myositis (Preuss. Stat. Militar-Veterinarbericht pro I9g00). A horse 
showed all the symptoms of hemoglobinuria after an operation that 
lasted an hour and a quarter, during the operation the animal struggled 
violently (Dages). A horse that was operated showed symptoms of 
paralysis three days after being cast, hemoglobinuria became evident 


290 INFLAMMATION OF MUSCLES 


on the fourth ; post mortem revealed myositis of the muscles of the limbs. 
A two-and-one-half year old colt was led 90 kilometers [55 miles], after 
which it stood a half day in the market. It showed general muscular 
paralysis, acute degenerative bilateral muscular atrophy in the gluteal 
and femoral regions, as well as hemoglobinuria; it was two months be- 
fore the animal was able to stand (Warncke). Hemoglobinemia 
occurred in a cow asa result of overexertion during transportation ; 
post mortem revealed paleness of the musculature and rupture of the 
right extensor of the patella (Ruegg). Villagio considers ‘‘shipping 
disease’ in cattle as a primary parenchymatous myositis due to over- 
exertion. 

SUPPURATIVE MyosiITIs.—This occurs in infected muscle- 
wounds, either in the form of a phlegmonous myositis, 
or muscular abscess,; it leads to suppurative liquefac- 
tion and necrosis of the muscle and its fascia, to fistula forma- 
tion, burrowing of pus, septicemia, and pyemia. In other 
cases interstitial myositis leads to encapsula- 
tion of the suppurative foci. The latter form is 
especially observed in the so-called shoulder abscess of 
the horse. It is partly due to infection with streptococcus 
and staphylococcus pyogenes albus, partly to that of the botryo- 
myces organism; it results in a circumscribed suppurative 
myositis of the mastoideo humeralis, the infection gain- 
ing entrance through superficial contused wounds in the skin 
assisted by the lymphatic system. In one case observed by 
Johne the tubercle-bacillus was the cause of a shoulder 
abscess in the horse. Multiple abscess formation of the 
muscle (myositis apostematosa multiplex) may have a meta- 
static origin as a result of the activity of pus-forming bacteria, 
or it may be caused by the streptococcus of strangles, it is 
observed during the course of pyemia and strangles. Treat- 
ment of suppurative myositis consists in free incision, or 
extirpation of the encapsuled abscess in shoulder tumors. The 
treatment of shoulder abscesses by means of parenchymatous 
injections of concentrated salt solution cannot be recommended 
(Schmidt); according to Schilling a horse treated by 
this method died in four days asaresult of gangrene and 
sepsis; Esser has employed it two different times with 
unsatisfactory results. 

INTERSTITIAL MyosiTis.—Interstitial fibrous myo- 


INFLAMMATION OF MUSCLES 291 


sitis (schlerosis of muscles) is a chronic inflammation of muscles 
characterized by a new formation of connective tissue, it leads 
to induration and contracture of the muscles, and may be 
caused by various inflammatory stimuli. It is 
observed during the course of chronic muscular rheumatism . 
after traumatic, suppurative, actinomycotic (wooden-tongue), 
tubercular, and botryomycotic myosites ; in muscular paralysis, 
and muscular atrophy. In some cases the inflammatory irri- 
tant is not recognized. In most cases, however, it originates 
from the activity of bacteria or parasites. Many cases of 
so-called rigidity of the os uteri in cattle may be designated as 
chronic interstitial myositis of the cervix uteri. Palat has 
described a peculiar case of multiple interstitial 
myositis inthehorse. Inan omnibus horse there occurred, 
without visible cause (encysted muscle parasites?), hard swel- 
lings on the throat, shoulder, thorax, and hips, as well as on 
the buttocks ; this was soon followed by a slowly developing 
general muscular weakness so that it was necessary to destroy 
the animal. On post mortem examination he found con- 
nective-tissue new-formations between the muscle-fibers of the 
groups named ; nodules were scattered through these areas ; 
in character they were fatty, calcified, and cartilaginous. 
Fibrous myositis is incurable unless actinomycotic in character 
(incision and iodin for wooden-tongue). 

OssIFYING MyosiT1is.—Osseous formation during 
the course of inflammation of muscle has been frequently ob- 
served in horses, dogs and swine (Kitt, Cadiot, Con- 
stant, Stephenson, andothers). The causes are extremely 
Memaple. Part of the cases are due to multiple 
exostosis formation at the seats of muscular 
attachments, ossification of the musclesisa 
secondary process. An interesting case of multiple 
hyperostosis formation in the horse has been described by 
Constant; it was identical with a form which is occasionally 
seen in young people, where it is termed myositis ossifi- 
cans multiplex progressiva. Because of chronic 
incurable lameness the patient was destroyed. On post mortem 
it presented the following characteristics: the attachment of 


292 INFLAMMATION OF MUSCLES 


the middle gluteal muscle was ossified, in the belly of the 
muscle there was located an osseous tumor the size of one’s 
fist, adhesions had taken place between the muscle and the 
pelvis; the pectineus and adductor longus muscles were also 
adherent to the pelvis and ossified. The internal obturator 
muscle formed a bony tumor (osteoma) on the inner margin 
of the obturator foramen ; finally, the ossified muscular attach- 
ments projected from the trocanteric fossa in the form of bony 
stalactites.—In other cases the ossifying myositis assumes the 
form of a tumor-like process (osteoma) or it may origi- 
nate from callus formation as a result of fragtures. In man 
ossifying inflammation of the muscles is occasionally observed 
after continued traumatic influences (exercise of the biceps, 
rider’s bone in the gracillis). Similar changes have been 
found in the biceps brachii of the horse as a result of bursitis 
intertubercularis. 


MYOSITIS SARCOSPORIDICA.—Inflammation of muscles due to the 
wandering of sarcosporidia (psorospermia, Miescher’s 
tubules, gregarinae) is especially|observed in swine, cattle, 
sheep, and horses (omnivora and herbivora). These are sicle-shaped 
spores arranged in capsules, when the capsule ruptures they are trans- 
formed into wandering cells which penetrate the adjacent musculature 
in the form of an inflammatory infiltration. In the shoulder and dorsal 
muscles of the horse they occasionally lead to the formation of sarco- 
sporidia-swellings as large as one’s fist, hard, and white or grey 
in color. In sheep they lead to the formation of encapsuled sarcospo- * 
ridia-cysts in the musculature of the esophagus, they reach the size of a 
pea. As a rule, however, the non-ruptured capsule is harmless, and it 
is a frequent condition. It is most often found in the muscles in 
the vicinity of the oral and pharyngeal cavities, as well as those of 
the esophagus, in the tongue, in the masseter, buccinator, laryn- 
geal, and pharyngeal muscles. Occasionally their presence in muscle 
leads to interstitial myositis with atrophy and cellular infiltration of the 
connective tissue of the adjacent muscular fibers. In other cases the 
flesh of cattle is clear and has an appearance of the flesh of calves, this 
is due to the presence of large numbers of sarcosporidia. In old 
horses, as well as buffaloes, sarcosporidia appearto 
be constantly present, in swine, also, they were found ina 
fourth of those examined by Perroncito. Among a hundred cases 
of cachectic sheep examined by Moulé, sarcosporidia were found 
in ninety-nine. Miescher’s tubules are very common in the mus- 
cles of herbivorous domestic animals, they seldom cause disease in the 


RUPTURE OF MUSCLES 293 


host; only in very rare cases have sy mptoms been observed which 
were due to inflammatory changes in the muscle as a result of the pres- 
ence of large numbers of sarcosporidia. Hoflich has described an in- 
teresting case of glossitis chronica sarcosporidica in a horse ; it was char- 
acterized by pronounced thickening of the tongue, deranged prehension 
of food, as well as emaciation. Dammann andv. Niederhausen 
observed dyspnea in a sheep and a goat as a result of inflammation 
of the pharyngeal and laryngeal muscles. Brouwier and Toka- 
renko observed difficulty in walking and standing, even complete 
muscular paralysis in steers. Virchow saw paralysis of the posterior 
extremities in swine. In two swine Brschosniowski observed 
loss of appetite, continued recumbent position, pain on pressure in the 
muscle, arched back, irregular movements of the hind parts, hoarse 
voice and fever (suspected trichinosis) ; after slaughter the musculature 
was found to be watery, cloudy, and permeated with numerous sarco- 
‘sporidia. For further information concerning the literature and devel- 
opment of sarcosporidia compare with symptoms of myositis trichinosa. 
(Cf: Friedberger and Frohner, Special Pathology of the 
Domestic Animals. 1904, 6 Ed., Vol. I.). 


2. RUPTURE OF MUSCLES. 


CAuSES.—Muscle-rupture occurs most often in horses and 
cattle, partly asa result of contusion and rupture from with- 
out, partly from overstraining and excessive muscular con- 
traction. Asin tendon-rupture, in addition to ordinary trau- 
matic causes, so-called spontaneous ruptures may occur asa 
result of diseased changes in the muscle. In general muscle- 
ruptures are not common; in the years 1888-1896 about 1800 
cases, 200 a year, were treated in the Prussian Army for 
contusion and rupture of muscles. As arule the ruptures 
involved the flexor metatarsi (20 cases per year). In the 
years 1886-1895 I found only twenty cases of muscle-rupture 
amoung 70,000 diseased dogs. 

OcCURRENCE.—Muscle-ruptures are most frequently ob- 
served in the following places: abdominal muscles 
(blows and overstretching during the course of pregnancy in 
cattle, less frequently from casting horses); muscles of 
the posterior limbs (overstretching from slipping, strug- 
gling when fettered, abnormal contraction when kicking); as 
wellasin the cervical, shoulder, and thoracic muscles 


294 RUPTURE OF MUSCLES 


(caused in the horse from running against wagon poles). The 
individual muscles most frequently involved are the tibialis 
anticus; rectus, obliquus, and transversalis 
abdominis; the quadriceps femoris; the glutei 
and gastrochnemii; the biceps femoris and 
brachii; the mastoideo humeralis, and pectoralis. 

Symptoms.—According to the physiological activity of 

the ruptured muscles one observes various derangements in 
function in the vicinity of the muscular apparatus, namely, 
lameness, symptoms of paraly sis, and prolapse. 
At the seat of rupture one can frequently recognize a space 
or cavity on the edges of which one may palpate the 
ruptured and afterwards swollen muscle; occasionally there 
exists a fluctuating swelling at the seat of rupture due to the 
formation of a hematoma following rupture of blood- 
vessels. The most important muscle-ruptures present the 
following symptoms: 
a) Rupture of the tibialis anticus muscle results 
in abnormal extension of the tarsal-joint with severe hanging- 
leg-lameness, dangling movements of the limb, and relaxation 
(folds) of the achilles tendon. On account of the muscles. 
being covered with the fascia of the limb and the extensor 
pedis, there is not usually visible, either depression, hematoma 
formation, or swelling. The prognosis is not unfavorable ; 
healing occurs in from one to two months. 

b) Rupture of the gastrochnemius produces the 
following symptoms: relaxation of the achilles tendon, and ina- 
bility to support weight at the knee or tarsal joints, such 
attempts being followed by excessive flexion. A space is usually 
present in the course of the gastrochnemius muscle. The 
prognosis is very unfavorable; healing in horses and cattle is 
rare. 

c) Rupture ofthe quadriceps femoris is followed 
by symptoms of paralysis of the quadriceps, namely, inability 
to support weight at the stifle (sudden flexion). 

d) Rupture of the abdominal muscles is occa- 
sionally followed by an abdominal rupture (hernia abdomi- 
nalis), this is especially true of cattle. 


ATROPHY OF MUSCLES 295 


e) Rupture of the mastcideo-humeralis results in the 
following symptoms: hanging-leg-lameness of the involved 
anterior limb, hematoma formation, occasionally abscess for- 
mation at the seat of rupture. 

TREATMENT.—Reposition of the ruptured muscle ends 
by means of the muscle suture is not practical in large domes- 
tic animals. Treatment consists in providing rest (slings, 
high tieing), in certain cases massage may be employed. 
Healing of the ruptured area occurs through the formation of 
a cicatrix as the result of an aseptic interstitial myositis ; oc- 
casionally cicatrization leads to contracture of the muscles and 
permanent shortening (torticollis after rupture of the mastoi- 
deo-humeralis). 

LUXATION OF MuSCLES.—This name signifies a change in position 
(dislocation) of certain muscles. The biceps femoris in cattle is occa- 
sionally involved as a result of slipping; the upper insertion of this 
muscle becomes detached from the trocanter and is displaced back- 
wards; it results in sudden lameness with extension of the entire limb 
and inability to flex the joints. Treatment isoperative (myotomy). It 


is stated that luxation of the biceps femoris and brachii is occasionally 
observed in the horse (Feger, Dominik). 


3. ATROPHY OF MUSCLES. 


CAUSES AND Forms.—Muscular atrophy is a symptom 
of various pathological conditions. The following forms are 
recognized : 

a) Simple muscular atrophy consists in diminution 
in the size and number of muscle-fibers without degenerative 
changes. It is observed in the form of so-called atrophy 
Srriactivity, it. is a constant. symptom ‘ot 
chronic lameness, it is most often found in connection 
with spavins and ringbones in the horse, and during the 
healing of bone fractures. The forensic importance of mus- 
cular atrophy for the determination of the duration of 
lameness is usually overestimated. Regardless of the fact 
that very often the relation between a lameness and an existing 
muscular atrophy is not sufficiently demonstrated, experi- 
en cesnias proved that a visible atrophy of the 
musctes of the gluteal or shoulder rezgions 


296 ATROPHY OF MUSCLES 


may develop much more rapidly than is gen- 
erally supposed. Atrophy develops more rapidly when 
the animal is in good condition and very lame. ‘The princi- 
ples maintained by Gerlach in his standard veterinary 
medicine (1872) are still in force. According to his work the 
parenchymatous fluids of the soft tissues may become visibly 
diminished in a very few days. In very painful cases of 
lameness the fatty tissue is visibly diminished after eight 
days; in very fat animals this may result in extensive atrophy 
of the limbs within two to three weeks. In mus- 
cular animals the flésh and cellular -tissiee 
have undergone visible atrophy “in @tiee. 
weeks. ‘Tendon becomes atrophic after‘a few months; the 
bones and hoof become visibly smaller after three to six 
months. 

; b) Degenerative muscular atrophy consists in 
cloudy swelling, fatty, wax-like or hyaline, and amyloid de- 
generations, as well as disintegration of the muscle-fibers. It 
develops after inflammation and paralysis of muscles. It is 
most often observed in the horse as a result of parenchymatous 
myositis of the longissimus dorsi, the gluteal, the quadriceps, 
and anconeus muscles in azoturia; it may also occur after 
overheating and casting. In this manner a very rapid form of 
atrophy may occur, so that high-grade muscular atrophy 
may be visible on the back and hips in a few days (even 
entirely unilateral). It is also observed after paraly- 
sis of the suprascapular nerve (atrophy of the 
spinati muscles), the radial nerve (atrophy of the anco- 
neus), the trigemminus (atrophy of the masseters), as 
wellas the recurrent (atrophy of the left laryngeal mus- 
cles; roaring). It is alsoseen in muscular rheuma- 
tism, indiseases of the dorsal marrow, as well 
asin chronic lead poisoning (atrophy of the laryngeal 
muscles ; roaring). 

c) Lipomatous atrophy or pseudo-atrophy (lipo- 
masia) of the muscles consists of an interstitial fat-cell pro- 
liferation with displacement of the muscle-fibers. 

TREATMENT. —Degenerative atrophy is usually an incur- 


NECROSIS OF FASCIA 297 


able condition. From a prophylactic standpoint, to prevent 
development, one may employ exercise, massage, vola- 
tile applications, and electricity, as well as inter- 
malstimuli (Strychnine, veratrin, caffein). 


HYPERTROPHY OF MUSCLE.—This term signifies a condition 
opposite to that of muscular atrophy, it is usually the result of increased 
activity (training). When horses are checked high there also develops 
a hypertrophy of the sterno-maxillaris, and sterno-thyro-hyoideus 
muscles as these are especially involved ; occasionally they present 
symptoms of myositis. Sometimes one finds unilateral hypertrophy of 
the mastoideo-humeralis in normal horses. 


II. DISEASES OF FASCIA. 
I. NECROSIS OF FASCIA, 


Causz#s.—Necrosis of the fascia is of special importance in 
the horse ; either its presence is unrecognized or its importance 
is underestimated. It results, either from a suppurative 
muscle-wound or from intermuscular and subfascial 
phlegmons. In both cases the fascia easily becomes 
necrosed because of its non-vascularity. On account of the 
firm structure of fascia, and because of the deep position and 
horizontal extension of many fascize, spontaneous sloughing 
and removal of the necrotic part is either very difficult or impos- 
sible. Necrotie portions of the fascize lead to chronic suppura- 
tive processes and fistula formation which can only be removed 
by operative means, that is, the necrosed tissue must be cut 
out. 


Symptoms.—That class of pus fistulee described in veteri- 
nary, surgery under the names fistulous withers, 
Mioiiearitistula, ofistula (of ithewh uttoaks, 
fistula of the fetlock, and coronary fistula 
are often maintained in the following manner: asa result ot 
suppurative and phlegmonous processes, necrosis of the fascia 
is caused in the depths of the dorsal, shoulder, and gluteal 
muscles, as well as in the fascia of the foot; this necrosis 
maintains a chronic suppurative condition. The necrosis is 
usually circumscribed ; it may, however, become very exten- 


25325 RUPTURE OF FASCIA! 


sive, for example, a diffuse subfascial phlegmon along the 
course of the longissimus dorsi may cause septicemia and ter- 
minate fatally. I have observed one example of this in a case 
of fistulous withers in the horse. 

TREATMENT.—When necrosis of the fascia is supposed to 
form the foundation of a fistula, one should not. hesitate to 
expose the dead pieces of fascia by means of extensive, 
deep, long, and broad incisions, through which all 
the necrotic portions are removed by means of the 
scalpel or scissors. In this manner fistulae of the 
withers, shoulder, and gluteal regions that 
have been in existence for months may be 
healed in a few weeks. One had better remove too 
much than too little from the diseased muscle and fascia, 
otherwise it will be necessary to repeat the operation. First 
make long, deep incisions, through which; 
under certain circumstances, pieces of flesh 
as large as a pound may be removed, exes. 
the fascia regardless of its extent; by follow- 
ing this method of treatment I have been able 
to cure many cases of fistulainthe horse. The 
after-treatment consists in preventing stagnation of the wound 
secretions in the depths of the fascia and muscles. This may 
be accomplished, either by means of open-wound treatment or 
drainage ; when practical it is best to employ permanent anti- 
septic irrigation of the operation wound for several days. 


2. RUPTURE OF FASCIA. 


RESULTS.—When the superficial fascia, not the muscle 
itself, becomes ruptured subcutaneously by means of blows or 
kicks, the soft muscular structure sometimes projects through 
the rent in the fascia. The involved area presents a visible, 
circumscribed swelling. So-called muscle-hernia is 
caused, especially in the horse, by kicks or pole-thrusts 
and occurs on the muscles of the limbs or neck. In the 
horse I have several times observed hernias of the semimem- 
branosus, of the mastoideo-humeralis, and of the anconeus. On 
palpating such a hernia one feels the sharp firm margin of 


PARALYSIS OF NERVES 299 


the fascia, and a soft area in the center. It is best to allow 
hernia of the muscle to recover without treatment ; when the 
condition is aseptic and lameness is absent, incision of the 
skin with subsequent suturing of the torn fascice is superfluous. 


STRINGHALT.—The term stringhalt signifies a peculiar derangement 
in the movements (ataxia) of the horse which is characterized by a 
sudden, jerking, involuntary, excessive flexion of all the joints of the 
hind limb. The causes have not been satisfactorily explained. An 
idiopathic form of stringhalt is recognized ; by some it is considered 
a contraction of the tibial fascia, a retraction of the tensor 
fascia lata, or the tendon of the peroneus; by others, a shortening of 
the transverse ligaments of the patella; while some refer it to a nervous. 
affection (disease of the spinal cord, peripheral neuritis, reflex neuro- 
sis). The treatment, therefore, is extremely divergent (incision of the 
fasciz, articular ligaments, tendons, nerves). Symptomatic string- 
halt forms one of the symptoms of spavin, ringbone and scratches, as 
well as various affections of the tarsal and pedal-joints (treads on the 
coronet, nail-pricks, clefts in the horn) ; they produce reflex symptoms. 
which may be compared with the twitching movements observed in 
people suffering from gout. 


III. DISEASES OF NERVES. 
I. PARALYSIS OF NERVES. PARESIS AND PARALYSIS. 


Forms. Various forms of paralysis of the nerves are 
recognized according to the grade, origin and extent. First, 
one recognizes two grades of paralysis, namely, simple 
weakness, paresis or incomplete paralysis ; and com- 
plete paralysis. According to the origin the different 
forms of paralysis are classified as cerebral, spinal, 
and peripheral, with reference to the seat of the disease 
in the brain, spinal column, or peripheral nerves. One also- 
differentiates motor and sensory, neurogenic and 
myogenic paralysis. Finally, with reference to the extent 
of the paralysis, itis termed monoplegia when only one 
limb or group of muscles is involved, when one entire side of 
the animal is affected it is termed hemiplegia; when bilat- 
eral, it is termed paraplegia. The division into atonic, 
spastic, organic, and functional paralysis is of slight import- 
ance in veterinary science. 


300 PARALYSIS OF NERVES 


CausEs.—The causes of paralysis of nerves are extremely 
variable. Cerebral and spinal paralysis may be due to the 
following causes: disease of the brain or spinal marrow, trau- 
mata, infectious diseases, and poisons; peripheral paralysis 
results from rupture, laceration, compression and inflammation 
of the peripheral nerves. 

DIFFERENTIAL DIAGNOSIS.—It is easy to diferentaen 
between cerebral, spinal, and peripheral paralysis. Paralysis 
due to an affection of the brain is usually characterized by 
monoplegia and hemiplegia. Frequently one of the cranial 
nerves is involved, and it is often accompanied by derangement 
of the consciousness. There are several symptoms by which 
spinal paralysis may be differentiated from cerebral. Ordi- 
narily it results in paraplegia, while the cerebral produces 
mono- or hemiplegia. This may be explained by the small 
size of the spinal marrow in comparison with that of the brain ; 
the pathological process usually affects the entire transverse 
diameter of the organ. For this reason the paralysis is both 
motor and sensory (anterior and posterior horns). This results 
in paralysis of all the muscles situated posterior to the diseased 
area in the spinal cord. Psychic derangements are usually 
absent in spinal paralysis, the cranial nerves usually remain 
unaffected, in cerebral paralysis they are usually involved. 
Simultaneous paralysis of the bladder and rectum indicates a 
Spinal affection. Spinal paralysis usually extends forward 
from the primary seat, ascending. Finally, trophie derange- 
ments in the paralyzed structures (muscular atrophy) are 
especially characteristic of spinal paralysis. Peripheral 
paralysis involves only individual] muscles or groups of mus- 
eles without cerebral or spinal complications. Occasionally it 
is very difficult to differentiate between neurogenic and 
myogenic paralysis. That form of parenchymatous myositis 
of the anconeus and quadriceps group, which is especially fre- 
quent in the horse, may -possibly be See, termed radial and 
crural paralysis. 

SYMPTOMS OF PERIPHERAL PARALYSIS.—While cerebral 
and spinal forms of paralysis produce symptoms of motor and 
sensory depression of the brain and spinal marrow, disease of 


PARALYSIS OF NERVES 301 


the peripheral nerves results in symptoms which vary ac- 
cording to the function of the nerve involved. In veterinary 
medicine the most important forms of peripheral paralysis 
result in the following symptoms : 

a) Facial paralysis resultsina unilateral par- 
meyetesGuetue muscles of the face. ‘The upper lip 
and the point of the nose are drawn in the 
direction of the normal side, the under lip is dis- 
torted in a similar manner or hangs downward. Food ac- 
cumulates between the cheeks and theteeth. The nasa] 
openings are constricted (peripheral paralysis). The ani- 
mal is unable to close the eye on the affected side, tears flow, 
the upper eyelid also hangs downward (ptosis). The ear 
may also be paralyzed (central paralysis). 

b) Trigeminal paralysis, caused by paralysis of the 
motor branches of the trigeminus, results ina paralysis of 
the muscles of mastication. It causes difficult pre- 
hension of food, salivation, dropping of the in- 
Pet1ot maxtila, and atrophy of the muscles 
Otemastication. ) 

c) Paralysis of the suprascapularis is char- 
acterized by a peculiar form of shoulder lameness in 
whichthe shoulder springs outwards when weightis 
placed on the foot of the involved side; a space variable in 
size is present between the thorax andthe elbow. There after- 
wards develops a pronounced atrophy of the spinati 
muscles and the rotaters of the shoulder. 

dj) “Paralysis of the radial nerve, which 
innervates the extensor muscles of the forearm and limb, 
especially the extensors of the elbow (anconeus), is only in 
part a general paralysis of the nerves. In other cases it is 
a myogenic paralysis of the anconeus (hemaglobinemia, 
myositis after casting). It is characterized by in- 
ability of the involved limb to support the 
body weight. All of the joints of the foot are flexed, 
they cannot be extended to support the weight of the body. 
By pressing backwards on the carpus, the limb may be main- 
tained in a position to support weight. The paralyzed muscles 
feel relaxed, finally they undergo atrophy. 


-302 INFLAMMATION OF NERVES 


e) So-called paralysis of the crural nerve is 
usually not due to paralysis of the nerve, but to that of the ex- 
tensors of the knee (quadriceps femoris); it may follow azoturia 
-orcasting. It results, when supporting weight, inan abnor- 
mal flexion of the knee-joint; as a result of par- 
alysis of the extensor muscles extension of the knee- 
joint is impossible. Chronic paralysis is followed by 
high-grade atrophy of the muscles Worms 
Bel ex 

f) Obturator paralysis results from pelvic frac- 
tures in the vicinity of the obturator foramen (inflammation 
and compression of the nerve through callus masses). , It is 
‘characterized by abduction of the involved limb as result 
-of paralysis and atrophy of the adductors. 

TREATMENT.—Therapy of nerve paralysis consists in the 
application of massage, cutaneous irritants, elec- 
tricity, methodical movements, as well as the sub- 
cutaneous injections of strychnine and veratrin. 
Among the peripheral forms of nerve-paralysis the following 
have a relatively good prognosis: the facial and the radial, 
paralysis of the suprascapularis and quadriceps is frequently 
incurable. 


2. INFLAMMATION OF NERVES. NEURITIS. 


CausEs.—Inflammation of nerves is of slight importance 
in veterinary surgery, it is very rare on the one hand, and on 
the other it is very difficult to recognize subjective symptoms 
on the part of the animal. The causes, asin man, are of a 
traumatic, infectious, rheumatic, andwagome 
nature. Traumatic neuritis occasionally develops at the central 
nerve-stump after resection of a nerve, this occurs as a result 
‘of inflammatory processes in the immediate vicinity which 
extend to the nerve. Inflammation of the planter nerves has 
also been, observed in the horse after interfering. Thom- 
massen has described a neuritis of the sacral plexus 
apparently due to rupture of the nerves from jump- 
ing. Hemiplegia laryngis (roaring in horses) is of special 
jmportance with reference to its relation to contagious 


INFLAMMATION OF NERVES 303 


pleuropneumonia. Itoccurs asa sequella of this dis- 
ease, and by many is considered a neuritis of the recurrent 
nerve which lies in the left pleural sac and is caused by an 
extension of the inflammatory process from the pleura to the 
nerve at the point where it passes around the posterior aorta ; 
this leads to unilateral paralysis of the laryngeal muscles. 
Also, paralysis of the laryngeal muscles which occurs in horses 
during the course of chronic lead poisoning is con- 
sidered by Thomassen as merely the result of a primary 
chronic neuritis of the recurrent characterized by connective- 
tissue new-formation and degeneration of the nerve. Accord- 
ing to recent investigations of von Marek, dourine in 
the horse is not an affection of the spinal marrow, but an 
infectious polyneuritis. He found round-celled infiltration 
and connective-tissue new-formation, especially in the ischi- 
adicus, tibialis, and’crural nerves, to some extent, also, in the 
median, infraorbital, tarsal, and intercostal nerves ; according 
to him the symptoms of paralysis in dourine are of a peripheral 
Gosure An infectious, multiple, peripheral 
neuritis occurs in animals and men in Dutch-India asa 
result of eating clodded rice, it is known as beri-beri- 
disease. According to some stringhalt in the horse is due 
to a neuritis of the ischiadicus (?). Inthe domestic animals 
one often observes inflammatory processes in the optic nerves 
and the retina: neuritis retrobulbaris, papillitis, and retinitis. 

ANATOMICAL CHANGES.—As in inflammation of other 
organs, the following forms of neuritis are also recognized: 
suppurative and interstitial; the first isan acute, 
the second a chronic form of neuritis. Macroscopically, 
acute neuritis is characterized by redness, swelling, and a 
serous or suppurative exudate between the fibrous bundles. 
Microscopically one finds dilitation of the blood-vessels, small- 
celled infiltration, nuclear proliferation of the sheath of 
Schwan, as well as degeneration of the marrow, and axis- 
eylinders. In chronic neuritis one finds connective-tissue 
new-formations (induration, schlerosis) with a subsequent de- 
generation and atrophy of the nerve-fibers. In the case of 
neuritis interstitialis proliferans of the sacral plexus described 


304 ' INFLAMMATION OF NERVES 


by Thomassen the plexus was four times as thick as normal 
and presented high grade connective-tissue proliferation with 
secondary atrophy of the nerve fibers. 

Symptoms.—Neuritis of the sensory nerves is charac- 
terized by severe pain inthe involved area, and paralysis 
and atrophy ofthe groups of muscles supplied by 
the affected nerves. Interstitial neuritis of the sacral plexus 
results in unilateral, severe muscular atrophy of one side of 
the hip, and one limb (glutei, biceps femoris, semi-tendi- 
nosus). In general, the clinical symptoms are very slight, | 
regardless of enormous pathological changes. Zietsch- 
mann observed two cases of chronic interstitial neuritis of the 
axillary plexus with neuroma formation in cattle, it resulted in 
pronounced connective-tissue proliferation, no genuine paraly- 
sis, but only slight muscular weakness of the affected limb. 
Treatment consists in the application of nervines (morphia, 
cocaine, strychnine, veratrin), as well as counter-irritants to 
the skin, massage, and electricity. Asa last resort for neuritis, 
sensory nerves may be severed (neurotomy), or a section may 
be cut out (neurectomy ), or extracted (neurexairesis). 

NEUROTOMY.—For certain incurable, painful forms of lameness in 
the horse (lameness from ringbone, chronic navicular disease, con- 
tracted hoof, chronic tendinitis, etc.) severing the nerve is a valuable 
palliative remedy. Animals that are otherwise useless are restored to 
a certain amount of utility. For indications of this operation see 
Bayer’s article in Volume I. of this hand-book. The changes 
that occur in a nerve that has been severed consist in 
fatty and granular degeneration of the entire periphery from the severed 
end of the cut section to its finest branches (descending degeneration). 
At the same time, however, there begins a collateral anastomosis for- 
mation with regeneration of the nerve-tissue from the central end, new 
nerve-fibers sprout from this stump, extend over the defect, and grow into 
the peripheral channels so that the function of the peripheral nerves is 
restored again after a certain length of time. In suppurative infection 
of the operative wound, as well as in continued traction on the central 
end of the severed nerve, there develops a chronic interstitial inflamma- 
tion of the central stump with the formation of a neuroma (see page 
a21)% 


DISEASES OF VESSELS 305 


DISEASES OF VESSELS. 
1. DISEASES OF ARTERIES. 
diy INFLAMMATION OF ARTERIES. ARTERITIS, 


ForMs.—One recognizes, first,an endarteritis, mes- 
arteritis, and periarteritis according to the location of 
the disease in the inner, middle or outer coat of the arterial 
wall. According to the causes and course, one further 
recognizes an aseptic, and septic or suppurative, 
a trattmatie and hematogenic, an acute and 
chronic, as well as a deforming, ossifying, and 
obliterating arteritis; the latter is characterized by clos- 
ure of the vessels. The acute suppurative and chronic deform- 
ing forms of arteritis are of special practical importance. 

a) Acute suppurative arteritis is the result 
of an infection of the arterial wall with staphylococci or strep- 
tococci. It either originates in the adventitia (periarteritis 
purulenta), or it may extend from the injured intima (suppura- 
tive thrombo-arteritis), or it may result from an embolism in 
the blood (pyemic metastasis). Suppuration of the intima 
results in a loss of the endothelium (suppurative necrotic 
endarteritis). 

b) Chronic deforming arteritis or arterio- 
schlerosis (atheroma or atherosis of the vessel) is a mul- 
tiple, focus-like, ulcerative endarteritis with connective-tissue 
thickening of the intima; the latter becomes necrosed and 
defective (so-called artheromatous ulcers); it is followed by 
fatty degeneration and calcification of the media. It leads 
to induration, stenosis, and obliteration, or dilitation and 
rupture of the diseased vessel-walls. While it is very frequent 
in man (symptom of old age, alcoholism, etc.), it is rarely a 
surgical defect in animals (iliac arteries, femoral arteries, 
axillary arteries). Endarteritis and dilitation of the anterior 
mesenteric artery as a result of strongylus armatus is of far 
greater importance for internal pathology. Cattle appear to be 
more predisposed to arterioschlerosis (endaortitis ossificans). 


306 DILITATION OF ARTERIES 


Atheroma of the aorta with a subsequent meningeal embolism is 
occasionally observed in horses. 


2. (DILITATION OF ARTERIES, ANHURYSaa 


Forms.—Aneurysms are divided into diffuse and cir- 
cumscribed. ‘The circumscribed forms are either cylin- 
drical (aneurysma cylindriforme), or spindle-shaped 
(A. fusiforme) or sac-like (A. sacciforme). A diffuse aneu- 
rysin is also termed angioma arteriale racemosum 
(aneurysma racemosum, anastomoticum, cirsoideum); it is a 
variety of new-formation, namely, angioma artericze plexiformee 
(angiomaracemosum). Aneurysma arteriovenosum. 
(varix aneurysmaticus, varix arterialis, arteriophiebectasia) 
is a special form due to the union of an artery and a vein 
(phlebotomy, castration of cattle). Aneurysma dessi- 
cans results from rupture of the intima and media, the 
adventia is raised by the pressure of blood (so-called false 
aneurysm). In rare cases the walls of the aneurysm are 
formed in the liver, intestines and other organs. 

CausEs.—In the horse the most frequent cause is the stron- 
gylus armatus, it is most active in the anterior mesenteric artery, 
where it produces a chronic deforming endarteri- 
tis. Asimilar cause results in dilitation and thrombosis of 
the femoral and iliac arteries as well as the axillary arteries. 
In other cases the aneurysm may havea traumatic origin 
(punctured wound), it may result from emboli, or from 
degenerative conditions of the vessel-walls when 
such conditions are exposed to the influence of concussions 
(blows, kicks) or strong muscular exertion (increased 
blood-pressure.) 

OcCURRENCE.—When compared with man, surgical forms 
of aneurysm are very rare in the domestic animals (infre- 
quency of arterioschlerosis). In the horse they have been 
most frequently observed in the following places: the aorta, 
the femoral and internaliliac arteries, in the 
carotid, the bracial, the femoralis, the popliteus, 
ischiadicus, facial, palatine, nasal, and internal 


DILITATION OF ARTERIES 307 


maxillary arteries. Aneurysma arteriovenosum has been 
observed in cattle in the vessels of the spermatic cord (sperm- 
atic artery and vein), following phlebotomy in the horse 
(jugular and carotid), as well as after injuries in the vicinity 
of the masseters (masseteric artery and vein). 

Symptoms. —Those that have a superficial location are 
characterized by a pulsating swelling, on compression 
of the artery by which it is supplied it either diminishes in 
size or entirely disappears. On palpation and ausculta- 
tion of the tumor friction sounds may occasionally be 
recognized in the form of a buzz or hiss on the inner wall of 
the aneurysm. Pressure on the neighboring nerves occasion- 
ally results in continued and severe pain. Onealso observes 
erosion of neighboring organs, even atrophy of the dorsal 
and cervical vertebree or the sternum. Aneurysms frequently 
lead to rupture and hemorrhage, or to sudden 
death from thrombosis and emboli. Spontaneous 
healing by means of obliteration and calcification is seldom 
observed. The most important forms of aneurysms in veteri- 
nary science are characterized by the following symptoms : 

a) AORTAL ANEURYSM results in a dilitation of the sinus 
of Valsalva at the origin of the aorta. Ina horse they become 
larger than a man’s head. Aneurysms in the abdominal cavity 
may become adherent to the neighboring organs (stomach, 
colon, small intestine); they also involve these organs and 
may lead to an erosion of the vertebral column. In most cases 
they produce no visible symptoms of disease for 
along time or during the life of the animal; other cases 
suddenly terminate in death as a result of in- 
ternal hemorrhage, previous marked symptoms being 
absent. Death from internal hemorrhage often follows con- 
cussion (casting, falls), or it may suddenly follow severe exer- 
tions ; the animal quivers, is very dyspneic, tumbles down 
and dies in a very short time. Peculiar paroxysmal 
Symptoms without immediate death as a direct result have 
also been observed. Lustig observed the following symptoms 
in a horse after severe exertion : weakness in the hind parts, 
sudden falling, pronounced dyspnea, as well as epilepti- 


308 DILITATION OF ARTERIES 


form cramps in which the head and neck were curved 
backwards and the feet extended, the animal rose again after 
ten or fifteen minutes. Symptoms of vertigo were constant 
in another horse that was affected with aneurysms in the pul- 
monary arteries. Barrier observed the following symptoms 
in a dog affected with aneurysm of the posterior aorta : emaci- 
ation regardless of a good appetite, pronounced debility, 
severe dyspnea on slight movement, and finally paralysis of 
the hind parts (symptoms of heart weakness). In a horse 
with an aneurysm the size of a man’s head in the thoracic 
aorta, Schmidt found a buzzing tone over the 
vertebral column that was synchronous with the action 
of the heart ; the animal was unable to take food, and traveled 
with a straddling and stiff gait in the hind limbs. Rupture 
of the aneurysm into the stomach (Vogel), and into the 
rectum (Labat, Cadeac, Duchene) has occasionally 
been observed. Mettam saw roaring (paralysis of the re- 
current) in a mare as a result of an aortal aneurysm the size of 
one’s head. 

b) Dilitation and thrombosis of the femoral and 
internal iliac arteries (seldom axillary ) in the horse may be due 
to the following causes: diseases of the inner layer of the artery 
(endarteritis) with the collection of a fibrinous coagulum on 
the surface and stenosis ofthe lumen,or embolic obliter- 
ation of the aortic branches from thrombi dislocated from 
the heart or from.aneurysms. One most frequently finds 
thrombi in both external iliac arteries, or in the femoral arteries, 
and in both internal iliac arteries. They are less frequently 
found in the axillary or brachial arteries, and rarely in the 
lumbar arteries. The terminations of the aorta and the origin 
of the arterial branches are usually dilated; the walls are 
thickened andaffected withatheromatous degener- 
ation; the intima is fatty, cloudy, calcified, and covered 
with ulcers. Within the vessel there is located a strati- 
fied and organized firm thrombus, clear in color, the lumen 
is more or less stenosed, often there remains only a narrow canal. 
Frequently the thrombus extends forward towards the aorta or 
backward into the arterial branches, it may be confined to the 


DILITATION OF ARTERIES 309 


aortic bifurcation. Occasionally the external or internal iliac 
arteries of one side are completely filled with the thrombus. 
In addition to the thrombus there frequently develops a second- 
ary compensatory hypertrophy of the heart. As a result of 
softening of the thrombus, emboli may pass into the peripheral 
arteries of the extremities. The described thrombi usually 
present no symptoms of disease while the animal is at rest. 
The very peculiar, characteristic symptoms of this disease are 
first observed after light or severe exercise in the wagon, 
under the saddle, or on the training ground. | | 

In thrombosis of the femoral andinternal iliac 
arteries which uswally occurs in horses, seldom in cattle, 
one first observes a progressive weakness in one or both poste- 
rior limbs. ‘The animal presents a characteristic paralysis 
which develops very suddenly. It usually involves one side, 
the animal has astaggering gait, strikes the affected 
hind foot against that of the opposite side, either brings the 
weight to bear only on the toe or drags the limb, trembles, 
falls down and lies jerking the limbs for a few 
minutes, and then lies back exhausted. At the same time the 
Pecqucncy-of the respiration is very rapidly 
Pieve@sed tie Heart beat. is bounding and. ae- 
celerated, the visible mucous membranes are strongly injected, 
perspiration breaks out over the entire body. The temperature 
of the paralyzed extremity is usually subnormal, pulsation is 
frequently absent in the tibial and planter arteries. After a 
few minutes the animal rises again; the symptoms of paralysis 
gradually disappear, after which recovery is soon complete. 
From a diagnostic standpoint, the fact that the disease can be 
produced experimentally by forced exercise is of great import- 
ance. On rectal examination of the thrombosed 
area one finds the following condition: the aorta and its 
arterial branches are dilated, thickened, unyielding, filled with 
along firm substance and non-pulsating on the affected side. 
In rare cases thrombus formation results in the production of 
emboli in the peripheral arteries and results in gangrene 
of the limbs. 

Thrombosis of the axillary arteries, a less frequent condi- 


310 DILITATION OF ARTERIES 


tion, is introduced by simple lameness of the involved 
side. The animal begins to stumble when moving, makes 
false steps, trips, drags the toes, is unable to raise the limbs, 
quivers on the affected side, and finally falls down. Deranged 
respiration, accceleration of the heart beat, and congestive 
conditions are not usually observed. After a short time the 
function is again restored. We 

c) Aneurysma arterio-venosum ofthe sper- 
matic cord occasionally follows castration of bulls. Along 
the course of the spermatic cord there develops a prominent, 
soft, cylinder-like swelling, following ligation, twisting, or tear- 
ingofthecord. Itisdue to fusion between the sper- 
matic artery and vein, so that the blood passes from 
the former into the latter (Gurlt, Collin, Kitt). 

d) Aneurysm of the anterior mesenteric artery is of 
no surgical importance ; see text-books on special pathology. 

TREATMENT.—The radical treatment of aneurysms that 
are accessible consists in extirpation of the dilated vascu- 
lar portion after carefully ligating the afferent and efferent 
vessels. Under certain conditions, however, the opera- 
tion is very dangerous as it frequently results in anemic 
necrosis of organs located peripherad to the ligature. They 
have in man, therefore, been treated as follows: methodical 
compression ; injection of irritants (liquor ferri chloridi, 
extract of ergot, alcohol) ; acupuncture and filipunc- 
ture (application of a copper suture, silver suture, iron 
suture, suturing with a horse hair); as well as galvano- 
puncture or electropuncture  (galvano-caustic 


punctures with needles). 

CaSUISTIC.—Steinmeyer has described an aneurysm of the right 
carotid at the heighth of the sixth cervical vertebra; it occurred in 
an eighteen-year-old horse that died very suddenly. There was aswell- 
ing on the ventral surface of the throat as large as a man’s head, he 
found it to be aspindle-shaped aneurysm four and one-half centimeters. 
in length witha transverse rupture three centimeters long, the intima at 
this spot was roughand covered withthrombi. Mouquet has observed 
a similar aneurysm of the left carotid in the pectoral region (compres- 
sible tumor with friction sound).—An aneurysm of the facialartery 
and its branches in a Simenthal cow has been observed by Vogel. It 
extended from the region where the artery winds around the face to the 


RUPTURE OF LARGE ARTERIES Sid 


end of the angular artery of the eye; it was sinuous in its course and 
presented sac-like dilitations, pulsations were well marked, on ausculta- 
tion buzzing and hissing sounds were recognized. An aneurysm of the 
posterior tibial artery in an ox has been described by Furla- 
netto: it formed an elastic, painless, pulsating, conical swelling on the 
inner surface of the tibia, it was fifteen centimeters in length and par- 
allel to the saphenic vein. Blaise observed an aneurysm of the 
pharyngeal artery in a horse, fatal rupture occurred resulting in 
symptoms of angina. Nouquet has observed an aneurysm of the 
artery that runs parallel to the saphenic vein: it was the result of phle- 
botomy and terminated in fatal hemorrhage. An aneurysm of the an- 
terior tibial artery with calcification of the walls has been extir- 
pated by Straube. Many casesof aneurysma racemosum on 
the under surfuce of the tail in cattle have been recognized by Sand. 


3. RUPTURE OF LARGE ARTERIES. VASCULAR RUPTURE. 


CausEs.—Rupture of large arterial branches is due to a 
direct injury, orit may have anindirect origin by means 
of concussion, falls, excessive muscular exertion—difficult 
pulls, during severe exertion while the animal is cast, in the 
act of vomiting, etc. In the last named cases of so-called 
spontaneous rupture, predisposition to rupture is occa- 
sionally present'in the form of pathological changes 
in the arterial walls. The following are among the 
pathological conditions that may occur: aneurysms, arterio- 
schlerosis, adipose degeneration of the vessel-wall, as well as 
erosion of the latter through new-formations. In many cases 
of spontaneous rupture of the aorta in the horse no visible 
microscopic changes are present in the vessel-wall. 

OcCURRENCE.—Rupture of the large vessels is most often 
observed inthe aorta and its branches as well as in the pul- 
monary arteries. Thesymptomsof internal hem- 
orrhage areas follows: staggering, tumbling, sudden col- 
lapse, paleness of the visible mucous membranes, cold ex- 
tremities, as well as a weak and finally imperceptible pulse, 
occasionally one also observes cerebral convulsions, and amau- 
rosis (anemic adipose degeneration of the retina), as well as 
vomiting. 

Ruptures of the aorta usually occur at its origin 
immediately behind the semilunar valves inthe vicinity 


312 RUPTURE OF LARGE ARTERIES 


of the sinus of Valsalva; at this point the blood-pressure is 
greatest, the walls are apparently thin and in most cases some- * 
what dilated; these regions form, therefore, an area of predilec- 
tion for the formation of aortal aneurysms. Rupture of the 
aorta occurs most frequently in horses; it is observed after 
casting, jumping, and falling. The blood flows into the peri- 
cardium which is found distended with blood on post mortem. 
Rupture of the anterior aorta is often caused by wagon poles 
that penetrate the tissues. 

Ruptures ofthe pulmonary arteries, likewise, are 
observed in horses after casting. Severe hemoptysis (cough- 
ing blood) as a result of the rupture of an aneurysm of the 
pulmonary artery into a large bronchus was observed in one 
case. Other ruptures that may be mentioned are: rupture of 
the femoral arteries and obturator arteries ain 
fractures of the pelvis; the internaliliac arteries in 
fracture of the last lumbar vertebra; the renal arteries 
from concussions; the colic arteries, when dilated witn 
aneurysms, from casting; the cecal artery asa result of 
a sarcoma; the diaphragmatic artery from blows; 
the carotid artery asa result of erosions from strangles 
abscesses; the posterior aorta through erosions from 
sarcomata ; the axillary artery froma severe pull; the 
left cervical artery, etc., from fractures.—Treatment of these 
ruptures is not usually possible. Ruptures of the palatine 
artery, internal carotid artery, etc., must be treated by ligation 
of the carotid artery. | 

OBLITERATION.—Adhesion and obliteration of the vessels as the 
result of endarteritis obliterans is seldom observed in the domestic ani- 
mals. Pirl has observed an obliteration of the posterior aorta 
in the horse. The aorta formed a solid cord between two aneurysms, it 
was about the thickness of one’s finger; anterior to the area of adhesion 
there branched finger-thick, newly formed collateral vessels. Eligio 
has described an obliteration of the iliac artery with symptoms of 
paralysis. I have recently (1904) observed a case of stenosis of 
the aorta ina horse (apparently congenital) that resulted in clin- 
icalsymptoms of thrombosis of the internal iliacs. 

EMBOLI.—These result from a solution of thrombic masses in 
the heart, in the aneurysmatically dilated anterior mesenteric ‘artery, 
femoral artery, etc., especially in the horse. Emboliin the pododerm 


INFLAMMATION OF VEINS’ 313 


lead to necrosis and loss of the horn capsule; emboli of the middle 
rectal artery to paralysis of the rectum (Casper) ; emboli of the ophthal- 
mic artery to sudden blindness (Arnold). 


II. DISEASES OF VEINS. 


I. INFLAMMATION OF VEINS. PHLEBITIS. 


Forms.—As ia arteritis, one also distinguishes in inflam- 
mation of the veins, an endophlebitis, mesophleb- 
Bune aud periphiebitis; an.acute and: chronic; 
Aieaseptic and septic (suppurative ) phlebitis. 
Pirpputative necrotic phlebitis; or suppura- 
tive thrombophlebitis is of special practical import- 
ance. It either occurs during the course of a phlegmon or from 
suppurative infection of venous thrombi through the entrance 
of pus-forming bacteria from without, or in pyemia from 
within, that is, from the blood (embolic, pyemic, metastatic). 

Symproms.—Phlebitis is characterized by a cord-like, 
nodular, firm thickening and induration along 
the course of the veins; passive edema also develops in 
the vicinity of .the diseased vein. The nodular formation is 
due to localization of the inflammatory process at the valves 
asaresult of retardation and engorgement of the blood at 
these points. Induration of the veins is the result of throm- 
bus formation in the blood and thickening of the walls. 
Through the release of infected portions of the thrombus 
suppurative metastases of distant organs may result, 
this is especially true of the lungs (pyemia). 

With reference tothe occurrence of phlebitis in the 
domestic animals it may be remarked that formerly, especially 
in the horse, it was more frequently observed than now 
(phlebitis of the jugular following phleb- 
otomy, so-called phlebotomy fistula). Suppura- 
tive omphalophlebitis of foals and calves (suppurative 
thrombophlebitis of the spermatic vein with consecutive pyemia; 
so-called foal-lameness) is less common since the introduction 
of umbilical antiseptics. On the other hand, the recent em- 
ployment of intravenous injections of chloral hydrate 


314 DILITATION OF VEINS 


in the horse has again introduced thrombosis of the veins and 
phlebitis of the jugular. Phlebitis in the vicinity of wounds 
and phlegmons is also of practical importance; inflammation 
of the saphenic vein in the course of phtegmons of the 
posterior limb (‘‘Einschuss’’) is not very common, the same 
is true of the internal iliac and femoral veins, the 
vena digitalis interna, radialis; bracts 
and cephalica, as well as thrombophlebitis of the nasal 
mucous membrane which occasionally leads to suspision 
of glanders in the horse. According to Zschokke the 
latter is characterized by the following symptoms: the septum 
nasi is dark-red in color; it is covered with stratified, light- wt 
yellow or reddish-grey aeathe like nodules, or cord-like eleva- . 

tions from one-half to two mm. in diameter; they consist of. a 

white venous thrombi that have their origin in a primary 
phlebitis. Ulcer formation as well as a suppurative or caseous 
exudate is wanting, this differentiates the condition from 
glanders. 3 


2. DILITATION OF VEINS. VARIX. |" PHLEBECTASTAs 
CausEs.—Similar to aneurysms, dilitations (varice 
phlebectasia) of the veins are found. Chronic inflammatio: 
of the walls of the veins, especially the intima (chro ni 
endophlebitis) is the most frequent cause. In addition 
traumatic influences, as wellas ulcerative and con 
genital dilitations of the veins must be considered. They 
are favored by local and general vascular engorgement. # 
SymMpToms.—Varices are present either in the form re) 
circumscribed nodular (spindle-shaped, sac-like, cy. 
indrical), or diffuse swellings along the course of the vein 
of the skin and mucous membranes. ‘They havea tendenc 7 
to become hemorrhagic and form ulcers (periphle 
bitis), they also result in thrombus formation (sup 
purative thrombophlebitis, pyemia), and in rare case . 
in calcification and caseation (so-called vein stones, 
phleboliths). In comparison with man varices in animals oe : 
very rare. Varices of the mucous membrane | ol 


A VEST POCKET PARTY. A 
Whenever the celebrated Chicago con- 
vention presents a new aspect it commands 
new admiration and defies calumny to with- 
hold, from Old Constitution Barnes, Dr. 
Pangloss Butler, Easy Murray Crane, the 
prodigious Penrose, the precise Hillis; and 
others of the inspired band the just meas- 
ure of praise théir-deeds compel. 
So well ‘did they serve and preserve the 
Republican party in its hour of peril that 
now the electoral votes of Utah and Ver- 
mont can confer upon a happy Republican 
the honor of unanimous Domination of the 
party for the vice presidency. 

Mrs. Margaret Zane Witcher, one of es 
four Utah electors, is ambitious. If the 
other three Utah electors will support her 
and if she can win Vermont’s four she is: 

‘nominated’? unanimously, candidate for 
vice: president. She will have all the ‘Re 
publican yotes. 

The Republican party has at ape some 
in the preserving process, but no one. will 
deny that it’s a-neat, tidy little party now. 
Old Constitution Barnes could. put it in 
his vest pocket, but he maak not be able to 
find it again, 


DILITATION OF VEINS ars 


the rectum, known as hemorrhoids, are very 
Uncommon in animals. The same is true of 
Wierbiows Of the veins of the lower limbs 
following repeated pregnancy (so-called vari- 
cose veins). Asa rule the diagnosis of such conditions 
is drroneous, for example, in the dog that condition recog- 
nized as hemorrhoids is usually a pathological condition of 
the anal glands; varix of the saphenic yein in the horse 
(so-called blood-spavin) hardly ever exists. The cause of this 
variation between man and animals is due tothe fact that 
chronic inflammatory conditions of the veins are far less com- 
mon in animals than in man. In man many affections of the 
heart and chronic puimonary diseases, as well as the upright 
position of the body, and pregnancy (pressure of the pregnant 
uterus on the veins) induce venous congestions more readily 


than in animals. Varices of the rectal mucous mem- 


brane (genuine hemorrhoids) have only occasionally been 
observed in horses, cattle, and dogs. Eckart found the 
following conditions in a horse: numerous nodules and cysts 
at the margin of the anus and termination of the rectum, they 
varied in size from that of a pea to that of a cherry, were smooth 
on the surface, slightly bluish in color, painful and hemorrhagic. 
Varices also occur in the spermatic cord (so-called vari- 
cocele), in the milk-veins of cows (hemorrhagic swellings 
about the size of a hen’s egg, Liebl); inthe vicinity ot the 
anus and scrotal covering in dogs (characterized by 
ulcer formation and hemorrhage; Moller, personal observa- 
tions); in the vesical mucous membranes of the dog (chronic 
hemorrhage of the bladder, Frick); on the anterior margin 
of the masseter muscle in the form of a varix of the facial vein 
in a remount horse (Preuss. Mil.—Ber. 1897); on the exter- 
nal mammary vein of the horse (personal observation); 
on the saphenic vein of the horse (Teply); as well as 
congenital new-formations of the skin of foals 
(W. Eber). Varix aneurysmaticus in the form of 
an opening of the spermatic artery into the spermatic vein 
after castration of bulls has been seen by several observers 
(Gurlt, Prinz, Meyer, Wagenfeld, Collin, and 


316 INFLAMMATION OF VESSELS 


others); it produces a pulsating, buzzing swelling in the cord. 

TREATMENT.—This consists in operative removal, or 
ligation. In addition to these methods, those used in hu- 
man surgery. may be employed; namely, removal with the 
cautery, ignipuncture (perforation with the Paque- 
lin), the injection of medical agents (ergot, alcohol, con- 
centrated carbolic acid), as wellas methodical compression. 
The latter methods may be experimentally employed. 


RUPTURE OF LARGE VEINS.—The following ruptures with fatal in- 
ternal hemorrhage have been observed, especially in the horse: rupture 
of the portal vein, the pre-and post cava, and the mesen- 
teric vein. Rupturesofthe jugularis, axillary vein, vena 
cephalica and saphena are not rare. 


III. DISEASES OF LYMPH-VESSELS. 


I. INFLAMMATION OF LYMPH-VESSELS. LYMPHANGITIS. 


CausEs.—Inflammation of the lymph-vessels is usually 
due to a wound infection disease induced by the 
entrance of pus-forming bacteria into the open lymph-vessels. 
It is most often found, therefore, in the following places: in 
the vicinity of infected, suppurative wounds; in phleg- 
mons; following too early incisions of hematomata in 
the region of the buttocks and limbs; asaresult of fistulae 
of the neck, fistulous withers, and injuries from 
saddle-galls. Therealso exist specific forms of lymphan- 
gitis ; namely, in horses during the course of glanders and 
strangles, as well as so-called pseudo-glanders 
(lymphangitis ulcerosa sui generis, mallei- 
forme lymphangitis); in cattle as a symptom of 
tuberculosis of the skin; in dogs during the course of 
so-called dog-distemper. A plague-like infectious 
lymphangitis with symptoms similar to glanders, but with a 
benign course, is observed in horses and mules in the French 
Army in Africa (Farcin d’Afrique, Lymphangite 
farcinoide); the lymph-vessels of the skin swell into 
cords and are covered with granulating ulcers, from the ulcers 
there is a discharge of normal pus. This ‘‘African’’ glanders 


DISEASES OF GLANDS Hy 


is also frequently observed in Southern France, Italy, Egypt, 
Russia, Japan, among American horses in the Philippines, 
etc. It is caused by a fungus-like parasite, saecharomyces 
(ecryptococcus) farcinosus (lymphangitis saccharo- 
mycotica, fungus-lymphangitis). So-called worm 
in cattle isa similar disease (Farcin du boeuf). 

Symptoms.—Lymphangitis is characterized by bead- 
like swellings along the course of the lymph-vessels, that is, a 
cord-like swelling interrupted by nodules. It is frequently the 
result of inflammation of neighboring lymph-glands (ly m ph- 
adenitis). Along the course of the bead-like swellings 
there occasionally develops, especially at the seat of the valves, 
numerous small abscesses (horse-distemper, dog-distemper ). 
Chronic lymphangitis leads to pronounced thickening of the 
skin (elephantiasisin glanders of the skin) .— 
Treatment consists in incision of the abscesses, as well as 
in the application of antiseptic fluids and ointments. 


2. DILITATION OF LYMPH-VESSELS. LYMPHANGIECTASIS. 


CausEs.—Lymphangiectasis is usually congenital 
and belongs in part to the chapteron tumors. It includes 
the so-called congenital elephantiasis, macroglossia, and ma- 
croscelia (see page 123). Incontrast to this form there is, 
however, an acquired dilitation of lymph-vessels ; it is espe- 
cially observed after chronic recurrent inflammations of the skin 
and subcutaneous tissue (inflammatory form of elephantiasis). 
So-called ly mph-cysts—cystic dilitations of the lymph- 
vessels—are a special form; these must not be confused with 
lymph-extravasates, that is, effusions of lymph as a 
result of subcutaneous rupture of lymph-vessels; or lymph 
fistulae, permanent ulcer-like openings in the lymph- 
vessels following injuries. 


DISEASES OF GLANDS. 


GENERAL REMARKS.—The general surgery of glandular 
affections in veterinary science is of importance only as applied 


318 INFLAMMATION OF LYMPH-GLANDS 


to certain glands, namely, the lymph-glands and the milk- 
glands which present a group of important diseased conditions. - 
From a surgical standpoint inflammation of the glands 
most frequently demands treatment. Glandular inflammations 
(lymphadenitis, mastitis) may be due to various causes and 
present extremely variable forms. From an etiological stand- 
point the following fornfs are recognized: traumatic, in- 
fectious, and rheumatic inflammation of the glands. In 
addition, there occurs a primary or independent form 
in contrast to a secondary or symptomatic form the 
latter is only a partial symptom of general disease (lympha- 
denitis in strangles, glanders, tuberculosis; mastitis in foot- 
and-mouth disease). According to the path of infection 
the following classification is observed: hematogenous, 
lymphogenous, and galactogenous inflammations 
of the milk-glands. According to the course inflammation of 
glands is classified as acute and chronic. ‘The classifi- 
-cation according to the anatomical character of the inflamma- 
tion is of special importance. According to this classification 
the following forms are recognized: parenchymatous, 
interstitial, suppurative, phlegmonous, catar- 
rhal, and specific. Parenchymatous inflammation in- 
volves the genuine secreting glandular substance; the inter- 
stitial form applies to the interglandular connective tissue ; the 
catarrhal to the excretory ducts and the collecting mechanism 
(milk-cysterns) of the glands. 

In the following will be described only inflammation of 
the two most important types of glands from a surgical stand- 
point, namely, the lymph-glands and the milk-glands. The 
description is brief and from a general standpoint. 


I. INFLAMMATION OF LYMPH-GLANDS. 


LYMPHADENITIS. 


CausEs.—Inflammation of lymph-glands is usually in- 
fectious in character. The infectious material enters 
either through a lymphogenous path, from without to within 
through the medium of the lymph-vessels (concentric lymph- 


INFLAMMATION OF LYMPH-GLANDS 319 


angitis), or hematogenous, carried to the lymph-glands by 
the blood. Lymphadenitis is most frequently observed as a 
result of the following conditions: infected wounds and 
phlegmons, nasal catarrh, suppurative alveolar periostitis, 
empyema of the sinuses of the head, pharyngitis, etc., it may 
further develop in aspecific formin strangles, glanders, 
tuberculosis, actinomycosis, and botryomy- 
cosis. From an anatomical standpoint one recognizes a 
parenchymatous, interstitial, and suppurative lymphadenitis. 
Perilymphadenitis is not uncommon, that is, an in- 
flammation of the connective tissue in the vicinity of the gland 
that leads to adhesions between the latter and the surrounding 
tissues (inferior maxilla). In the horse lymphadenites are 
most often observed in the intermaxillary lymph- 
glands; in cattle in the lymph-glands of the neck and 
awe rT: 

SYMPTOMs.—a) Parenchymatous lymphadenitis 
is characterized by swelling of the gland, it is usually 
acute in development and is accompanied by slight degree of 
pain. Afterwards the swelling either becomes resorbed, or 
the parenchymatous lymphadenitis changes into the suppura- 
tive or chronic form. It is most often observed as a wound in- 
fection disease following injuries, as well as subsequent to 
catarrh of the mucous membranes. 

b) Suppurative lymphadenitis is especially ob- 
served during strangles in the horse. It is characterized by 
severe swelling and pain as wellasfever; it usually 
terminates in fluctuation and abscess formation. If 
the pus is not discharged outwards it becomes thickened 
(caseation), or it is resorbed by the blood (pyemia, septice- 
mia, petechial fever). 

c) Chronic interstitial lymphadenitis is char- 
acterized by the foviawing symptoms: a painless, hard, 
circumscribed swelling of the gland ; occasionally it be- 
comes adherent to the underlyingtissues, and it 
may contain hard nodules (glanders, tuberculosis, chronic 
catarrh). 

TREATMENT.—Chronic interstitial lymphadenitis is in- 


320 INFLAMMATION OF THE UDDER 


curable, occasionally it is necessary to extirpate the enlarged 
gland for diagnostic purposes. Suppurative inflammations are 
treated by means of incisions and antiseptic irrigation. 
The parenchymatous form is treated with moist warmth, 
parenchymatous injections, camphor) oimoe 
ment, iodoform ointment, grey ointmeéentand 
other resorptives. 


2. INFLAMMATION OF THE UDDER. MASTITIS. 


Causxs.—In cattle, infections are the most frequent 
causes of mastitis, itis seldom of traumatic or rheumatic origin. 
The infection may have a galactogenous, 
lymphogenous, or hematogenous enttrag@es 
As aresult of bacteriological investigations in recent years, in 
addition to tubercle-bacilli, actinomyces and botryomyces 
fungi, a number of specific organisms have been 
found to cause mastitis. Ordinarily they gain entrance through 
the ductof the teat (galactogenousinfection). The 
following are the most important : 

a) Bacterium phlegmasiae uberis, idemm. 
cal with the colon bacillus. 

b) Streptococcus agalactiae contagiosae 
a Md vouive MS tye) tooo s 

c) Staphycococcus mastitidis. 

d) Staphylococcus mastitidis “ganas 


e) Galactococcus versicolor, tuly wspemm 

i yBaciMusep yo sien es, 

g) Micrococcus, tetragenes, 

Forms.—1. Parenchymatous mastitis is partly 
galactogenous through the entrance of bag‘eria of mastitis 
from without, partly hematogenous, for <example, during the 
course of foot-and-mouth disease (symptomatic mastitis), it 
affects the columnar epithelium of the alveoli and small milk- 
ducts. It leads to a firm, painful, febrile swelling and pro- 
nounced enlargement of the inflamed quarter of the udder. 
Milk from the affected part contains a flocculent coagulum and 


INFLAMMATION OF THE UDDER 321 


fibrin, sometimes it is even yellowish and wheyish, or even 
colored with blood, finally the milk-secretion is entirely sus- 
pended. If resorption does not occur there develops, 
either a permanent inflammatory hypertrophy of the 
udder with marked enlargement and induration, or an atro- 
phy with shrinking and permanent diminution in size of 
the affected quarter. In other cases it passes into a sup- 
purative andeven gangrenous form of mastitis. 

2. Catarrhal inflammation of the udder (catarrh of 
the udder) is localized especially on the mucous membranes of 
the teat-canal (squamous epithelium), the milk-cysterns and 
large milk-ducts (columnar epithelium). In the beginning the 
gland itself is either slightly swollen.or normal in size. It is 
characterized by the watery, flocculent, wheyish condition of 
the milk. Afterwards it leads to induration, stenosis 
and obliteration of the teat-canal, as well as to the for- 
mation of connective-tissue septa in the milk-cysterns which 
lead to hard milking, drying up of the milk (agalactia), and. 
atrophy of the affected quarters. In other cases catarrhal 
inflammation extends to the interstitial tissue and results in 
chronic induration with permanent increase in size 
(pseudo-hypertrophy) of the diseased quarters. Occasionally 
it assumes a contagious form (‘‘gelber Galt,’’ agalactia 
catarrhalis contagiosa). | 

peewee nlerinonots mastitis Gnflammatory 
edema of the udder) is an infectious inflammation ot 
the skin and subcutem, as well as the interglandular connec- 
tive tissue of the involved quarter. It is characterized by a 
firm, painful, diffuse, hot, febrile swelling of the affected quarter 
without qualitative changes in the milk in the early stages of 
the disease. It isa result of infection from without (traumata), 
or within (accompanying symptom of parenchymatous mas- 
titis) and should not be confused with the non-painful and 
non-febrile, physiological stagnation edema of cows advanced in 
pregnancy. ‘The chronic course results in chronic induration 
and atrophy of the diseased quarter. 

Pec uronicinterstitial or indura'tive mas- 
titis consists in an inflammatory new-formation of connec- 


322 INFLAMMATION OF THE UDDER 


tive tissue with atrophy of the genuine parenchyma of the 
udder. It may develop independently as a chronic inflamma- 
tion during the period when the animal is not giving milk, 
when it leads to a painless, hard, often very pro- 
nounced enlargement of an entire quarter of 
the udder; the milk is watery and flocculent. It often re- 
sults from a previous acute, catarrhal, parenchymatous, or in- 
terstitial, as well as a tubercular and actinomycotic mastitis ; 
in the latter cases the nodular swellings are frequently 
painful during the early stages of the disease. 

5- Suppurative inflammation of the udder, abscess 
of the udder (suppurative, apostematous, stereptococcal, 
staphylococcal mastitis) is a circumscribed suppurative liquefac- 
tion of the parenchyma of the udder during the course of pa- 
renchymatous and catarrhal mastitis.. It is characterized by 
high fever, fluctuating areas on the udder, as well as a puru- 
lent condition of the milk, it occasionally leads to the forma- 
ient of milk-fistule. 

6. Necrotic inflammation of the udder is especially 
common in sheep through the influence of specific microorgan- 
isms (micrococcus mastitidis gangraenosze) ; it is less frequent 
in cows where it occurs during the course of severe parenchy- 
matous mastitis of a putrid character. During the course of a 
suppurative mastitis necrotic portions of tissue may be 
sloughed off (sequestration, mortification or mummification of 
the udder). In these cases the milk is fetid and ichorous in 
character ; the necrotic portions of the udder are discolored 
and sloughed off. , 

With reference to tuberculosis, actinomycosis, 
and botryomycosis of the udder see pages 167, 159 and 
163. 

TREATMENT.—Treatmerit varies according to the form of 
mastitis. In general the following methods are important: 
frequent milking, the application of antiseptic agents 
(ointments containing borates or salicylates), 
early incision of abscesses, removal of necrotic por- 
tions, amputation of single quarters, operative treatment 
of stenoses and partitions in the teat-canals and milk cysterns. 


INFLAMMATION OF THE SKIN © 323 


Massage is contraindicated in all forms of infectious mastitis. 
For further details compare with text-books on special surgery 
and obstetrics. 


SURGICAL, DISHASHS OF THH SKIN, SUBCUTEM 
AND MUCOUS MEMBRANES. 


I. SURGICAL DISEASES OF THE SKIN. 
I, INFLAMMATION OF THE SKIN, DERMATITIS. 


CausEs.—The causes of inflammation of the skin are 
traumatic, chemical, thermic, infectious, and specific in char- - 
acter (dermatitis traumatica, caustica, combus- 
tionis, erysipelatosa, suppurativa, malleosa). 
According to the course and extent one recognizes a circum- 
scribed and diffuse, superficial and deep, acute and chronic: 
dermatitis. 

Forms.—From a practical standpoint it is:important to 
differentiate between the following anatomical forms of in- 
flammation of the skin: 

a) Hrythematous dermatitis or erythema 
of the skin consists of an inflammatory hyperemia of the 
skin. According to the causes the following forms are recog- 
Higed: erythema traumaticum (pressure, rubbing); 
toxicum or ab acribus (irritating chemicals, black 
soap in dogs); caloricum and solare (heat, burning of 
first degree, action of the sun) ; as wellas exanthemati- 
cum (symptomatic erythema in swine-erysipelas). Small, 

circumscribed erythema is termed macula; the multiple 
‘form is termed exanthematous roseola. Inflammatory ac- 
tive hyperemia must not be confused with passive hyperemia 
or vascular engorgement (livid, cyanotic) ; the former is 
characterized by a clear, arterial color of the reddened skin. 

b) Serous dermatitis, when diffuse, is termed 
inflammatory edema (serous infiltration of the cutis) ; 
while the circumscribed formistermed vesicular eczema 
(multiple vesicles), and bullous dermatitis (large 


324 INFLAMMATION OF THE SKIN 


vesicles beneath the epidermis) ; urticaria or pomphus 
indicates a circumscribed serous infiltration. 

c) Suppurative dermatitis*is the réesuittomee 
infection of the skin with pus-bacteria. It is either superficial 
or diffuse (Suppurative dermatitis), or assumes the 
form of a circumscribed collection of pus beneath the epidermis 
(pustular dermatitis, pustule, pus-yesteuiee 
Acne and furuncle isa multiple, suppurative inflamma- 
tion of the skin confined to the hair-follicles (suppurative 
folliculitis). 

d) Hemorrhagic dermatitis occurs symptomat- 
ically in anthrax, either diffuse in the form of hemorrhagic 
edema, or circumscribed in the form of carbuncles. 
Hemorrhagic dermatitis may also have a traumatic origin 
(contusion ), or result from a complication of infection with sim- 
ple hemorrhage (petechia, vibices, ecchymoses, hematoma, 
suffusion). 

e) Gangrenous dermatitis or necrotic der 
matitis (necrosis, gangrene) follows burning and freezing, 
application of caustics, and contusions, as well as the action of 
certain infectious materials (necrosis bacillus) ; compare with 
the chapteron gangrene. Ulcerative dermatitis is-a 
similar form ; compare with the chapter on ulcers. 


f) Chronic hyperplastic dermatitiewoceum 
partly as a chronic indurative dermatitis or schlerosis 
(schleroderma, pachyderma, elephantiasis, tyloma), partly as 
a verrucose dermatitis (‘‘Straubfuss’’ bristle foot, 
‘‘Ingelfuss’’ hedgehog-foot), partly as a squamous in- 
flammation (callosities, squamous eczema). 

The treatment of dermatitis of the skin consists in 
the application of antiseptics, astringents, protective agents, etc. 


ACNE AND FURUNCULOSIS.—It is customary to employ these terms 
to indicate that form of suppurative dermatitis which is confined to the 
follicles of the skin (Suppurative folliculitis). The smaller 
nodules are termed acne; the larger, pustule-like nodules which lead to 
necrosis of the follicles are termed furuncles. They are most often 
found in the region of the saddle and girth in the horse (so-called saddle- 
mange, callosity, nodular enlargement, lichen), as well as on the skin 
over the bridge of the nose in dogs (muzzle, pustular form of acarus 


BURNS 325 


mange); they have also been observed in cattle (udder), and sheep 
(abdomen). Treatment is purely surgical (incision, curettage, excision). — 
In contrast to furuncle, carbuncle forms a specific, sanguino-gan- 
grenous, circumscribed inflammation of the skin and mucous membranes 
due to the anthrax bacillus. (In man, several furuncles arranged in a 
group are also termed carbuncle). 

ECZEMA AND EXANTHEMA.—Eczema is a multiple dermatitis 
caused by external irritants; it runs atypical course and assumes 
various forms; namely, aczema erythematosum, vesiculosum, papulo- 
sum, pustulosum, madidans, crustosum, impetigenosum, and squamosum. 
That form of dermatitis found on the volar surface of the fetlock, desig- 
nated as scratches, is of special surgical importance. According to the 
degree of inflammation it is termed eczema erythematosum, madidans, 
crustosumn, impetigenosum, squamosum, etc., and may be designated re- 
spectively as dermatitis erythematosa, suppurativa, gangrenosa, etc. 
Exanthema, likewise, isa multiple inflammation of the skin; it is, 
however, only asymptom of internal disease, and is not, therefore, of 
surgical importance (vesicular exanthema in foot-and-mouth disease, 
exanthema of small-pox, exanthema of swine-erysipelas, strangles, dog- 
distemper, etc.). Hxanthema of the mucous membrane istermed en- 
anthema. (For further details concerning exanthema and eczema 
see: Friedberger and Frohner, Special Pathology. Sixth Ed., 
Mok 2 T-.:\. 


2. BURNS. COMBUSTION. 


= 


CAUSES.—Inflammation of the skin as a result of burns 
(dermatitis combustionis) is rarely observed in the 
domestic animals, except when heat is used asa therapeutic 
agent. In horses and cattle it is usually due to fires in the 
stable, burning the pododerm with a hot iron, contact with 
electric wires (street railways), hot inhalations, and taking 
hot food. Cats and dogs are burned with boiling water 
or hot milk. In horses, in addition to burns of the skin and 
pododerm, the mucous membranes of the respiratory apparatus 
are burned by inhalations of hot air during conflagrations. 
Extensive burning of the skin and mucous membranes is very 
dangerous. 

DEGREE. According to the duration and intensity of the 
caloric influence, three degrees of burning are recognized : 

a) The first degree is characterized by a mere red- 
ness of the skin (dermatitis combustionis erythematosa), 


326 BURNS 


which may be combined with a slight serous infiltration. 

b) The second degree is characterized by the for- 
mation of blisters (dermatitis combustionis bullosa) ; there 
is a circumscribed collection of serous exudate between the 
epidermis and rete Malpighi; a croupous inflammation 
exists on the mucous membranes. , 

c) The third degree consists in the formation of an 
eschar (dermatitis combustionis escharotica), whereby the 
burned portion becomes necrotic (dry gangrene) ; afterwards, 
as the result of a suppurative, demarking inflammation it is 
sloughed off. Necrosis of the pododerm in horses is especially 
dangerous (exungulation). Complete charring of an 
organ has been termed burning of the fourth degree. 

In addition to local changes, extensive burning is also ac- 
companied by severe general disease and fatal re- 
sults. Experience in men has demonstrated that death is 
certain when more than half of the surface of the body is in- 
volved, even when in the form of the first degree. The result 
is usually fatal when a third of the surface of the body is 
burned. I have learned by personal observations on horses 
that, under certain conditions, burning may be fatal when 
only a fifth or a tenth of the surface is affected ; the animal 
suffers from an attack of hemoglobinuria. These results are 
especially common when the mucous membranes of the respi- 
ratory tract are simultaneously affected from inhalations of hot 
air. Such cases present on post mortem, in addition to the 
changes on the skin, fibrinous laryngitis, bronchitis, and 
pharyngitis, glossitis and edema of the lungs, hemorrhagic 
gastroenteritis, hemoglobinuria, infarcts of hemoglobin in the 
kidneys, hemorrhages in the spleen and heart, as well as 
parenchymatous hepatitis and myocarditis. 

There are various explanations of the causesof death 
in the severe, rapidly fatal cases of burning. It is considered 
partly a poisoning, partly a derangement inet 
circulation, partlya paralysis of the nerves asa 
direct result of the burn. According to the toxic theory the 
burning of the blood in the cutaneous capillaries results in a 
decomposition of the blood andleadsto hemoglo- 


BURNS 427 


binemia, which determines the fatal course ; carbon dioxide 
poisoning results from a diminution of the supply of oxygen 
taken up by the red blood-corpuscles. In a short time 
Pomoees dtattities “of hemoglobin ,circulate 
[eeeivea lm) the blood; it ¢anses hemoglobi- 
magteerntarets of ihemoglobin in the kid- 
memcn as well as hemorrhages in the spleen 
and gastric mucous membranes with sec- 
Mme vemecarosis (diphtheria) of the latter. 
In addition to free hemoglobin, the influence of a high degree 
of heat on the blood apparently gives risé to other toxic bodies 
(ammonia, pyriden bases, prussic acid, ptomaines). On the 
other hand, materials formed by the decomposition of white 
blood-corpuscles have been found. According to the nature of 
fibrin ferment, these lead to coagulation inthe capillaries 
of the inner organs, followed by severederangementsin 
the circulation and necrosis, especially in the mu- 
cous membranes of the intestines (Silberman, and Welti). 
The earlier supposition, that death was due to cooling of 
the body, cannot be maintained ; experience has shown that 
death occurs in man when the burned are permanently placed 
in warm baths. In many casesa reflex paralysis of the 
nervous system asaresult of excessive irritation of the 
nervous system and overheating of the blood (44 C.) may 
be accepted as a cause of sudden death from burning. When 
the disease exists for some time, death results froma sub- 
Pea went, aifection: especially. through a septic 
infection of the blood as the result of resorption of septic, 
putrid, and toxic materials from the gangrenous areas in 
the skin, pododerm, and mucous membranes (septicemia). 

TREATMENT.—The local treatment of burns is essentially 
the same as for other wounds; apply an aseptic bandage to 
fresh wounds as soon as possible to prevent the entrance of 
infectious material (pus-bacteria). If infection has already 
taken place, antisepsis must replace asepsis. Nitrate 
Omepaaver isi the best.antiseptic for.burns. This 
possesses, in addition to strong disinfecting properties, a pro- 
tective (eschar of silver) and anesthetic action, it is employed 


328 FREEZING 


in the form of a 5-10 per cent aqueous solution, or ointment. 
Other antiseptic protectives are bismuth salts, oxid of zinc, 
iodoform in combination with talk or amylum as a dusting 
powder, etc. Recently, sodium bicarbonate in the 
form of a dusting powder, as wellas picric acid (bandage) 
has received special recommendation. Among the older reme- 
edies may be mentioned so-called lime liniment (lini- 
mentum contra combustiones), a mixture of equal portions of 
lime water and linseed oil. Amputation is indicated in severe 
burning of the extremities (tail, ears, toe-joint). Injuries 
due to caustics are treated similar to burns. 


3. FREEZING. CONGELATION. 


DEGREE.—In freezing, also, one recognizes three degrees : 
redness, vesicles (congelatio bullosa), and necrosis 
(congelatio gangrenosa). In contrast to arterial hyperemia of 
burning of the first degree, the redness of freezing is due to a 
passive, venous hyperemia. The second degree is an inflam- 
matory reaction of the body in the course of which it leads to 
the formation of thrombi and severe disturbances in the circu- 
lation. The third degree of freezing leads to gangrene, which, 
in contrast to the dry gangrene of burns, is moist. Death fol- 
lows extensive freezing as a result of pronounced falling of the 
body temperature, in other cases, as in burns, fatal septic 
diseases develop afterwards. 

OCcCURRENCE.—The domestic animals, especially the 
horse, are very resistant to cold (winter coat). Usually the 
injurious influence of cold in winter involves the pododerm, as 
well as the skin of the coronet, the fetlock, and the pastern. 
In the Russio-Turkish War (winter 1877-78) the Russian 
army horses were repeatedly affected with a necrosis of the 
pododerm similar to that which results from burns (J ewse- 
jenko). The African and Arabian horses seem to be very 
resistant to cold. According to Cadiot these horses in the 
Franco—German War (1870-71) were more resistant than the 
French horses. Inthe Crimean War (1854-56) the African | 
horses were also able to endure more than the English. Dur- 


FREEZING 329 


ing the French Expedition against Algeria in the winter of 
1845-46 the African horses remained well, while 25 per cent 
of the army were frozen to death. Freezing of the scrotum is 
common among the cattle of Denmark (Bang). Treat- 
ment of frozen tissues is the same as that of burns. 


LIGHTNING-STROKES.—Large animals are the most frequent suffer- 
ers from this affection, this is especially true of cattle at pasture and 
military horses. In stables, the standing and large animals are espe- 
cially exposed ; for example, among nine horses in a stable only the five 
that were standing were struck (Ziegenbein). The actton of the 
stroke is variable; sometimes the skin is burned; the soft parts may 
undergo mechanical rupture; the nervous system may suffer from 
electric concussion and paralysis; atother times the action 
ischemical in nature, the red blood-corpuscles are de- 
composed (lightning-figures caused by the solution and diffusion of 
hemoglobin in the region). The burns of lightning are either superfi- 
cial (singeing of the hair), or deep enough to involve the muscle. Ina 
horse that was killed by a lightning-stroke, lines one half cm. broad 
extended from the inferior surface of the thorax down the inner sides of 
both anterior limbs as far as the hoofs, the hair on this strip was singed; 
the subcutem in the same region was strongly infiltrated with blood 
(Sachs. Jaresbericht. 1894). A horny cicatrix remained in one horse 
after healing had occurred (Miller). In cows spotted with black the 
stroke caused circumscribed areas of necrosis in the vicinity of white 
hairs (Urbain). Experience has shown, that in light- 
ning-paralysis the prognosis is relatively favorable. 


Strong electric currents have an action similar to that of lightning. 
According to Cadiot and Arloing a horse dies only after a long 
time—several minutes—when exposed to a stream of 500-550 volts. 
Horses only fall under the influence of 200-400 volts, 100 volts causes 
slight trembling and collapse at the knees. 550-700 volts, when applied 
for a short time, does not always result in death. The injuries in the 
killed horses are partly in the form of circumscribed necrotic wounds, 
partly the result of falling, rolling, and kicking. The horses that are 
not killed often present nervous derangements (stupor, weakness), 
these symptoms usually disappear, occasionally the paralysis is perma- 
nent (effusion of blood inthe brain). In a horse that came in contact 
with the wire of an electric lamp the death was lightning-like in its 
rapidity. Post mortem merely showed large quantities of blood in the 
lungs and brain, as well as relaxation of the heart-muscle. Another 


horse became rigid, the muscles quivered for several hours. (Wobher- 
ling). I observed a case in the horse in which there occurred burning 
of the second degree. 

Sun-stroke and heat-stroke are of no surgical importance. 


330 CUTANEOUS EDEMA 


Sun-stroke is a disease of the brain and medulla oblongata (hyperemia, 
inflammation, apoplexy, paralysis); heat-stroke is a hyperthermia of the 
body (overheating, dissolution of the blood, derangement of the heat 
regulators). For further information see: Friedberger and Froh- 
ner, Special Pathology. 1904, Vol. II). 


II. SURGICAL DISEASES OF THE SUBCUTEM. 
I. EDEMA. 


Forms.—The term edema indicates a serous infil- 
tration of the subcutaneous connective tissue. According 
to the causes the following forms of edema are recognized : 

a) Inflammatory edema (acuteedemamougme 
cellular tissue) is a serous inflammation of the subcutis and 
cutis ; it is, therefore, characterized by rise of tempera- ~ 
ture, pain, swelling that often developenaaa. 
idly, active hyperemia, and pronounce quaas 
tension of the skin. It is most often founding 
horse in the form of so-called ‘‘Hinschuss’’ [special form of 
phlegmon of the hind limbs]. It also occurs as so-called col- 
latereal edema in the vicinity of suppurative inflammatory 
foci (abscesses). The following are specific forms of inflam- ' 
matory edema: malignant edema, hemorrhagic 
edema (anthrax), and blackleg. 

b) Stagnation edema (edema of thecellular tissue) 
occurs through hydropic infiltration of the subcutis after stag- 
nation of the venous blood or lymph. The edematous swell- 
ing, therefore, is cool, painless, more or lessvegae 
doughy, and oceasionally it retains ‘dienes 
sions made withthefingers. Incontrast to the clear 
artrial redness of inflammatory edema, it presents a reddish-blue, 
cyanotic or livid color. It is found as follows: in old and 
atonic horses that remain standing for a long time; in preg- 
nant mares and cows, on the abdomen, udder, (edema of the 
udder), and on the posterior limbs; when the head is held 
down for a long time; following venous thrombi and phlebitis. 
Hydremic edema (anasarca) is a special form of 
stagnation edema due to chronic diseases of the heart, lungs, 


CUTANEOUS EMPHYSEMA 331 


liver, kidneys, and diseases of the blood (hydremia); it is 
found congenitally in the form of so-called water-calves (water- 
moles, lard or moon-calves). 

TREATMENT.—The therapy of the different forms of edema 
is extremely variable. Treatment of inflammatory edema 
consists in antisepsis, hydrotherapy, in the application of an- 
tiphlogistic remedies, incisions, and injections; stagnation 
edema is treated with massage, and compression, as well as 
internally. 


2... HMPHYSEMA. 


FormMs.—This is an. accumulation of air in the 
subcutaneous connective tissue (pneumatosis) ; two forms are 
recognized: traumatic and septic emphysema. 

a) Traumatic emphysema occurs, either after the 
entrance of air through external injuries in the skin, espe- 
cially in the vicinity of the thorax, throat, and orbital cavity ; 
or after internal injuries to the thoracic walls and lungs 
(coughs in cattle), after rupture of the esophagus, perforation 
of the rectum:and subcutaneous fractures of the tracheal 
tings through which air passes from within to without. Ac- 
cording to the origin there is recognized an expiration- 
emphysema (injuries to the trachea and the lungs), and 
an inspiration- emphysema (aspiration through 
pumping movements of the thorax, the abdominal walls and 
the extremities). Under certain influences the accumulation of 
air under the skin produces the following conditions: the en- 
tire back is extensively swollen, the swelling is soft, 
Dapity, crackling, painless, and not.accompa- 
Meme yerocal beat, itis characterized by ia 
tympanitic tone on percussion; the animal often 
. has a deformed appearance. In general the prognosis of trau- 
matic emphysema is favorable, the air is gradually resorbed 
through the blood- and lymph-vessels, and the general condi- 
tion is not usually disturbed. It is a peculiar condition, that 
inflammation of the subcutaneous connective tissue is usually 
absent although infectious material must gain entrance with 


ERE: DISEASES OF THE MUCOUS MEMBRANES 


the air. Treatment consists in massage and compression ; 
frequently this is unnecessary. 

b) Septic (gangrenous, spontaneous) emphysema is 
due to the entrance of gas-forming bacteria into the subcutis, 
namely, bacillus phlegmonz emphysematosz (gas-phlegmon), 
a gas-forming variety of the bacterium coli, and other micro- 
organisms. ‘The gas beneath the skin is not composed of air, 
as in traumatic emphysema, but of putrefactive gases 
(carbureted hydrogen, sulphureted hydrogen, hydrogen, car- 
bonic acid). In contrast to traumatic emphysema, one finds 
symptoms of septic inflammation in the skin and subcutem, the 
general conditions frequently undergo severe changes (septi- 
cemia). Blackleg is a specific form of septic emphysema. 
Following death of a fetus, there develops as a result of decom- 
position, a subcutaneous, intermuscular, and subserous emphy- 
seina (so-called emphysematous fetus or “dunst- 
kalib’ =svaporT-calio: 

The treatment of septic emphysema consists in mak- 
ing extensive incisions, removal of the gas, thorough disinfec- 
tion of the subcutis, as well as eventual amputation of the 
diseased parts (tail). 

TYMPANITIS.—The accumulation of air in body cavities and hollow 
organs (tympanitis, meteorism) is occasionally of surgical importance; 
it may follow injuries (pneumothorax following perforating tho- 
racic wounds), and frequent-y receives operative treatment by means of 
puncture (tympanitis of the rumen, meteorism ote 
intestine). Tympanitis of the guttural pouch 1m foals 
is a peculiar affection, it is due partly to the entrance.of at- 
mospheric air, partly to the development of putrefactive gases. Occa- 
sionally one also observes the entrance of air into the abdominal 
cavity (castration) and into the veins (aspiration of air, see page 4). 


Ill. SURGICAL DISEASES OF THH MUCOGS 
MEMBRANES. 


INFLAMMATION.—Inflammation of the mucous membranes 
presents the same causes and forms as inflammation of the 
skin. The following are of special surgical importance: in- 
flammation of the oral mucous membranes (stomatitis), 


DISEASES OF THE PODODERM 333 


mucous membranes of the nose (rhinitis), eyes (conjunc- 
tivitis), pharynx (pharyngitis), vagina (vaginitis, 
colpitis), uterus (endometritis), bladder (cystitis), 
and rectum (proctitis). The following forms of inflam- 
mation occur on the mucous membranes named : 

I. Hrythematous inflammation of the mucous 
membranes. 

2. Catarrhal inflammation of the mucous membranes. 

3. Suppurative inflammation of the mucous mem- 
branes. | 


4. Apthous (vesicular, phlyctenular) inflammation. 

5. Pustulous inflammation of the mucous membranes. 

6. Ulcerative inflammation of the mucous membranes. 

7, Croupous (fibrinous, membranous) inflammation 
of the mucous membranes. 

8. Diphtheritic inflammation of the mucous mem- 
branes. 

g. Phlegmonous inflammation of the mucous mem- 
branes. 

to. Chronic hyperplastic (granular, verrucose, 
polypous, cystic, fibrous, follicular, etc.) inflammation of the 
mucous membranes. 

There are also specific inflammations of the mucous 
membranes (actinomycosis, tuberculosis, glanders, etc. ). 

Treatment consists in the application of disinfectant, as- 
tringent, and protective materials. 


TV. SURGICAL DISEASES OF THE PODODERM. 


INFLAMMATON.—Inflammation of the pododerm (pododerm- 
atitis) presents the same general causes and forms as inflam- 
mation of the skin. The following special construction, how- 
ever, causes variations : the resistance of the protective horn- 
eapsule (hoof, claws); failure of the subcutis over the third 
phalanx, the pododerm occupying the relation of the perios- 
teum ; as well as the exaggerated development of the papillary 
body and the rete mucosum. The following forms are recog- 
avedmesuperticialand déep; “acute and chronic; 


334 CONGENITAL MALFORMATIONS 


serous, ‘suppurative, hemorrhagic Micon 
and ‘gangrenous or necrotic; infectious 
pricks) and non-infectious or aseptic (aminitis) ; 
chronic productive (keratocele, chronic laminitis) ; as 
well as circumscribed and diffuse pododermatitis. 
Because of failure of the subcutis over the third phalanx 
phlegmonous inflammation occurs only at the coronet 
(subcoronary phlegmon), inthe vicinity of the lateral 
cartilage (parachondral phlegmon), asvwell as in the 
fatty frog (phlegmon of the fatty frog). | 


APPENDIX. 


CONGENITAL MALFORMATIONS OF SURGICAL IMPORTANCH. 


GENERAL CONSIDERATIONS. — Aside from mere patholog- 
ical and anatomical considerations, congenital cases of malfor- 
mations are of less interest in animals than in man; they are 
seldom of practical surgical importance, as new-born animals 
with extensive malformations are usually killed. Still there 
are a considerable number of congenital malformations in vet- 
erinary surgery that are amenable to plastic operations. These 
are anomalies of the genital and digestive apparatus, eyes, 
udder, skin, and extremities. 

CONGENITAL MALFORMATIONS OF THE GENITAL APPA- 
RATUS.—In male animals cryptorchidism, that is, re- 
tention of one or both testicles in the abdominal cavity (ab- 
dominal cryptorchid), or in the inguinal canal (inguinal cryp- 
torchid) is of greatest practical importance, it most frequently 
occurs in stallions. With reference to treatment see: Opera- 
tionslehre by Bayer (Bd. I), [or: ‘‘The Castration of Cryp- 
torchid Horses and the Ovariotomy of Troublesome Mares’’ 
Hobday']. Failure of one (monorchid), or both testicles 
(anorchid) israre, aplasia of one or both testicles is of 
great importance in the castration of cryptorchids (failure to 
find the testicles). In exceptional cases, three testicles (t ri- 


tTranslator’s reference. 


CONGENITAL MALFORMATIONS 335 


orchid) have been observed. An occasional forward dis- 
location of the testicle, lateral to the penis, is peculiar to 
‘dogs ; in these animals there also seems to be a predisposition 
to the development of new formations in the testicles. Con- 
genital fissures are also found in the urethra, the urethra does 
not form a closed canal opening at the end of the penis, but 
may have a dorsal opening (epispadia), or a ventral open- 
into the sheath (hy pospadia). It may even form a semi-canal 
or fistula, opening at the scrotum and perineum. Congenital 
stenosis of the prepuce (phimosis) sometimes occurs. 
One frequently observes new-born foals in which there is an 
opening in the urachus from which urine is constantly drop- 
momeeouet tha. Of the urachus);. the, following 
have also been described: cystic urachus, ectopia 
of the bladder as a result of exstrophy, as well as 
cystic diverticulum after obliteration of the urethra. 
In female animals one frequently observes congenital 
cystic ovaries, congenital closure of the vagina (at re- 
Serv acinae peanmormallytlarge development 
of the hymen, failure or incomplete development of the 
cervix aud uterus, atresia and obliteration of the tubes. 
There further occurs the formation of hermaphrodites, 
and apparent hermaphrodites (pseudo-hermaphrodites) ; I 
have operated two cases of penis-formation in the 
vagina of mares. Finally, theformation of rudimen- 
tary teats (after-teats) is not, uncommon on the scrotum 
or in its vicinity in bulls, oxen, goats, and rams. 
' CONGENITAL MALFORMATIONS IN THE DIGESTIVE APPA- 
RATUS.—Fissures in the lips and intermaxillary bones (hare- 
lip, labium leporinum), as well as the palate (cleft pal- 
ate, wolf’s jaw, palatoschisis) are especially observed in pup- | 
pies and foals as well as cattle. They are seemingly 
uncommon; in 70,000 cases of diseased dogs I have ob- 
served only three cases of cleft palate, and only one case of — 
hair-lip. Congenital shortening of the frenum linguze has been 
observed in calves. On the maxille, especially in the horse, 
it frequently occurs that the jaw is abnormally long and pro- 
jecting (prognathism), or abnormally short and receding 


336 CONGENITAL MALFORMATIONS 


(brachygnathism). These are frequently the cause of so- 
called pike- and carp-mouth (brachygnathia superior and in- 
ferior.) Many anomaliesoftheteeth are alsocongenital, 
especially the disposition to shear-mouth due to narrowness be- 
tween the rows of teeth in the inferior maxilla; the persist- 
ence of the incisor milk-teeth ; the occurrence of supernumer- 
ary teeth (polyodontia), and canine teeth in mares. ‘The fol- 
lowing may also be mentioned: congenital dilitation of the 
guttural pouches in foals which results in catarrh of 
the guttural pouches; congenital diverticulum of the 
esophagus in horses as a result of aberation at the second 
branchial cleft; congenital hernias in horses, dogs, and 
swine, which occur in the form of umbilical, inguinal, and 
perineal hernias. Perineal hernia (hernia perinealis, vesicalis, 
cystocele) in dogs is due to a protrusion of the recto-vesical 
excavation; in bitches to a protrusion of the vesico-vaginal 
excavation. Congenital adhesions of the anus and rectum 
(atresia ani, atresia recti) have been seen in dogs 
and swine. The formation of a cloaca (common opening 
for the rectum and vagina, or bladder and urethra) is fre- 
quently congenital in animals. According to Mayr one 
must differentiate between typical and atypical forms, as well 
as between cloacas that have, and do not have, fissures in the 
bladder. The following are the most important of the latter 
forms: atresia ani simplex, atresia ani vesicalis, 
(anus vesicalis), atresia urethralis (anus urethralis), 
atresia ani, vaginalis (anus vaginalis), atresia anil 
with cloaca formation at the vestibule ofthe 
vagina (anus vestibularis), as well as anus vulvalis, 
perinealis, and scrotalis. 

CONGENITAL MALFORMATIONS OF THE EvzE.—Dermoid 
of the cornea is a congenital anomaly thatis relatively 
frequent in dogs and calves, it is also seen in horses, sheep, 
and swine. It consists of a spherical projection of the skin 
over the cornea at the externalangleof thelid; Schindelka 
has collected statistics on twenty-nine personal and reported 
cases, nine of these were in cattle, eight in dogs; I have 
observed and operated fourteen cases in dogs. The following 


CONGENITAL MALFORMATIONS 337 


also, are not rare in dogs and horses: coloboma, that is, 
congenital fissure and defect of the iris and tapetum ; congen- 
ital cataract (cataracta congenita), and atrophy of the 
retina (amaurosis); hyperthrophy of the uveal 
bodies inthe horse; congenital closure of the lids in dogs 
(atresia palpebrarum congenita) ; congenital atro- 
phy of the entire eye in dogs and foals (microphthalmus); 
retention of portions of the pupillary membrane (membrana 
pupillaris perseverans), as well asthe vitreous artery 
(arteria hyaloidea persistans); finally, atresia of 
the lachrymal duct at its nasal opening. 

CONGENITAL MALFORMATIONS OF THE UDDER.—A con- 
genital smallness of one or more quarters of the udder in com- 
parison with the others (micromazia) is common in cows. 
Abnormally large development of the milk-glands (macro- 
mazia) in male animals, especially in billy-goats, forms an 
opposite condition. Complete failure of an udder in female 
animals (aplasia or hypoplasia of the udder) is 
rare. Congenital closure (atresia) of the openings of the 
teats, as well as congenital stenosis of the teat-canal (steno- 
sis) is occasionally observed in cows. Cows frequently have 
an excessive number of teats or after-teats (six instead of 
four), and dwarf-teats, as well as failure of the fourth teat 
(congenitally three-teated). 

CONGENITAL MALFORMATIONS OF THE SKIN.—In addi- 
tion to dermoid cysts inthe skin and subcutem (occurring 
in dogs partly in the form of multiple furunculosis), horses, 
cattle, and goats are frequently affected with a congenital 
baldness (atrichia, alopecia); the opposite of this 
condition, excessive growth of hair (hypertrichosis), 
occurs in horses on the mane and tail. An abnormality that 
is frequent in fully developed dogs consists in an excessive 
growth of the claws, especially the after-claws (hyperony- 
chia), with excessive bending (onychogryposis) and 
growing into the skin (paronychia) ; according to my ex- 
perience one per cent of all diseased dogs (540 cases in 70,000) 
are thus affected. So-called ‘‘hornsaule’’ keratocele of the 
horn-capsule is an abnormality that is sometimes congenital in 
the horse. 


338 CONGENITAL MALFORMATIONS 


CONGENITAL MALFORMATIONS OF THE SKELETON AND 
Limps.—Abnormal smallness of the entire skeleton, in part a 
result of fetal rachitis, is termed dwarf formation (micro- 
somia or acromicria); the opposite condition, excessive 
development of the limbs, is termed macrosomia, acro- 
megalia,- leontiasis ossea, ete.  Accondinpame 
Zschokke, restricted growth of the bones that depends on 
a derangement in the development of the cartilage (achondro- 
plasia) is termed cretinism; that which depends on a de- 
ranged ossification is termed rachitis. A surplus number 
of entire extremities (polymelia) in the domestic ani- 
mals is less frequently observed than an excessive number of 
toes and claws (polydactylia); the latter anomally on 
the anterior feet of swine, as well as on the inner surface of the 
metacarpus in the horse, has been frequently described and 
successfully operated. ‘The same is true of adhesions between 
the claws to form a single claw (syndactylia) in swine. - 
Double formations also occur, especially in calves; I have 
operated one such case of omopagus parasiticus. 
Failure of entire extremities (amelia), or single toes (per- 
odactylus) is observed in new-born animals. Finally, one 
occasionally finds congenital fissure formation in the bones of 
the skull (cranioschisis), and the vertebral column 
(spina bifida), the former is occasionally combined with 
protrusion of the brain (encephalocele), as well as con- 
genital curvature of the vertebral column of the horse and deer 
(ky phoscoliosis). 

CONGENITAL MALFORMATIONS OF THF RESPIRATORY 
Tract.—An abnormal enlargement of the bones 
occasionally causes dyspnea and chronic nasal catarrh in 
foals. Congenital deformities also occur in the trachea 
in the form of stenosis, dilitation, and sabre-scabbard-like 
flattening, it may also roll on its axis or assume the form of a 
spiral. Goitre is very often congenital in puppies. The 
following congenital malformations are also of importance : 
ear-fistula (see page 90) and congenital deafness; I 
have observed the latter several times, especially in Dalmation 
dogs, when it was without doubt a hereditary affection. 


INDEX. 


A 


Abnormal fragility 193. 
Abnormal granulations 21. 
Abscess 34. 
Acarus 184. 
Accidental wound infection} dis- 
eases 25. 
Acne 324. 
Acromegalia 229. 
Acromicria 229. 
Actinobacillosis 155. 
Actinomyces 153. 
Actinomycoma 153. 
Actinomycosis 153. 
Actinophytosis 138. 
Actol 59. 
Acuepressure I5. 
Adenofibroma 113, 
Adenoid 147. 
Adenoma 147. 
A#gropila 177. . 
African glanders 346, 
Airol paste 60. 
Alcohol 60. 
Aloes, tincture of 60. 
Alopecia 337. 
-Aluminum acetate 60. 
Alveolar sarcoma 127. 
Amelia 338. 
Anchylosis 254. 
Aneurysm 306. 
Angioma 122. 
Angioma racemosum 123. 
Angiosarcoma 127. 
Anorchid 334. 
Anthrax 54. 
Antiphlogistics 83. 


Antiseptic treatment of wounds 55. 
Anus vaginalis 336. 
Anus vesicalis 336. 
Aortal aneurysm 307. 
Aortal stenosis 312. 
Aphthee 333. 
Aplasia of the udder 337. 
Aplasia of the testicles 334. 
Apostema 34. 
Aqua chlorata 60, 
Argentum nitricum 59. 
Arrest of hemorrhage 12. 
Arteries, 305. 
inflammation of, 305. 
dilitation of, 306. 
Arterioschlerosis 305. 
Arthritis 234. 
deformans 238. 
fibrinous 244. 
granular 243. 
pannous 244. 
purulent 236. 
pyemic 245. 
serous 234. 
sicea 244. 
ulcerative 244. 
uric 244. 
Aseptic treatment of wounds 55. 
Athermoa 150.’ 
of the vessels:305. 
Atherosis 305. 
Atmocausis 16. 
Atresia 96. 
Atrichia 337. 
Atrophy 96. 


B 
Bacillol 59. 


340 INDEX 


Bacillus celluleformans 41. 
pyocyaneus 26. 
pyogenes 26. 
tetani 52. 

Bacterium coli 27. 

Bacteremia 38. 

Bacteria of pus 25. 

Bandage 61. 

Bezoare 177. 

Birth-mark 122. 

Bismuth salts 60. 

Bites 7. 

Blackleg 54. 

Bleeding I. 

Blood-disease 16. 

Blood-extravasate 65. 

Blood-cysts I51. 

Bone, atrophy of 228. 
diseases of Igo. 
formation of I9I. 
fractures of Igo. 
glanders of 221. 
development of IgI. 
hypertrophy of 229. 
inflammation of 220. 
necrosis of 226. 
tuberculosis of 171. 
wounds of 23. 
tumors of I1g. 

Bone-caries 227. 

Bone-callus 207. 

Bone-fistule 87. 

Bone-marrow, inflammation of 221 

Boric acid 60. 

Botryomyces 161. 

Botryomycoma 161. 

Brachygnathism 336. 

Bullous dermatitis 323. 

Burns 325. 

Burrow’s solution 60. 

Bursee 259. 

Bursitis 278. 


GC 


Calcium permanganate 60. 
Calf-lameness 245. 


Callosity 112. 

Callus 207. 

Callus tumors 209. 

Camphor 60. 

Camphor spirits, bandage of 32. 

Cancer 133. 

Cancroid 134. 

Carbolic acid 59. 

Carbuncle 324. 

Caries gI. 

Carcinoma 133. 

Caro luxurians 21. 

Cartilage-tumors 117. 

Cartilage-wounds 24. 

Cataplasm 80. 

Caustics 92. 

Cellular theory 74. 

Chemotaxis 73. 

Chloride of zinc 60. 

Cholesteatoma 127. 

Chondroids 118. 

Chromatophores 128. 

Cicatrix 11g. 

Cicatricial contracture 22. 
hypertrophy 22. 
keloid 111. 
stenosis 97. 

Cicatrization Ig. 

Clavus 148. 

Cleft-palate 335. 

Cloaca 336. 

Club-foot 257. 

Coagulation necrosis gI. 

Coenurus cerebralis 182. 

Cold 81. 
apparatus for application of 81. 

Coloboma 337. 

Colon-bacillus 27. 

Combustion 325. 

Comminuted fracture 195. 

Compound fracture I94. 

Compression I5. 

Compression stenosis 97. 

Concrements 174. 

Condyloma 145. 

Congelation 328. 


Congenital malformations 334. 


Congenital stenosis 97. 
Connective-tissue tumors 99. 
Connective tissue, 
inflammation of 28. 
Contra-fracture 192. 
Control of hemorrhage 12. 
Conquassion fracture 195. 
Contused wounds 7. 
Contusion 64, 253. 
Cooling apparatus 81. 
Corpora libera 177, 258. 
Corpora oryzoidea 177, 258. 
Cranioschisis 338. 
Creolin 58. 
Crepitation 200. 
Cresol 59. 
Crural paralysis 302. 
Cryptogenic septicemia 4o. 
Cryptorchidism 334. 
Cutaneous irritants 83. 
Cutaneous horn 148. 
Cylindrical-celled cancer 134. 
Cylindroma 127. 
Cysticercus cellulosz 184. 
Cystic calculi 175. 
Cystoma I51. 
Cysts 149. 


D 


Deafness 338. 

Deforming arthritis 238. 
Degenerative atrophy 96. 
Degenerative cysts I5I. 
Decubitis 91. 
Decomposition, bacteria of 29. 
Demarcation, line of 95. 
Depression 195. 

Dermatitis 323 

Dermatol 60. 

Dermofilaria 183. 

Dermoid of the cornea 336. 
Dermoid cysts 100 
Desmoid growth gg. 
Diapedesis 73. 

Diastasis 249. 


INDEX 


Digital compression I5. 
Dilitation 98. 

Diphtheria 93. 

Dislocation of fragments 195. 
Distomum hepaticum 184. 
Distorsion 252. 

Diverticulum 98. 

Dumdum bullet 11. 


E 


Kar-fistula go. 
Eburnation 221, 229. 
Ecchondroma 117. 
Ecchymosis 65. 
Kctasia 98. 
Kctopia of the bladder 337. 
Eczema 325. 
Edema-bacillus 49. 
Edema, inflammatory 330. 

malignant 49. 
Elephantiasis 112. 
Hlectric influence 329. 
Embryonic theory oo. 
Emigration 73. 
Emphysema 331. 
Emphysematous fetus 332. 
Enanthema 325. 
Encephalocele 338. 
Enchondroma 117. 
Endarteritis 305. 
Endosteum rot. 
Endothelioma 127. 
Endothelial cancer 127. 
Enostoses 11g. 
Epispadia 335. 
Epithelial growths 99. 
Epithelioma 148. 
Erosion 227. 
Erysipelas 46. 
Erythema 323 
Eschar 92. 

healing under 21. 
Exanthema 325. 
Exfoliation 228. 
Excretion-fistula 87. 


341 


342 INDEX 


Exostosis 119. G 
Expiration-emphysema 331. 
Exudate 86. 

Extravasate 65. 
Extravasation-cyst I51. 
Exudation-cyst I51. 


Galactococcus 320. 

Galls 275. 

Gangrene 91, 95. 

Gangrena nosocomialis 53. 
Gangrenous emphysema 95. 
F Gas-gangrene 95. 
Gas-phlegmon 31. 

Gastric fistula go. 
Gastrophilus 183. 

Genuine cysts I5I. 

Germ theory Ioo. 
Giant-celled sarcoma 126 
Glanders 53. 

Glands, inflammation of 318. 
Glandular-celled cancer 134. 
Glioma 130. 


Facial paralysis 301. 
False joint 209. 
Farcin d’Afrique 316. 

du boeuf 317. 
Fasciz 283. 

necrosis of 297. 

rupture of 208. 
Fatty tumor 113. 
Ferment fever 309. _ 
Fever 37. 


Fibroblasts 18. oni 
Fibro-epithelial new-formations ee 
Gout 246. 


144. 
Fibrocarcinoma 134. 
Fibroma 107. 
Fibroid 107. 
Fig-wart 144. 
Filaria cincinnata 183. H 

hemorrhagica 183. Hairsbaliauene: 


irritans 183. he 
lachrymalis 183. Hair-lip 335. 


Granulation IIg. 
Granuloma 21. 
Gregarinz 292. 
Gun-shot wounds 8, 


medinensis 184. Halisteresis. 
papillosa 183. Healing per primam 17. 
Fire-mark 122. per secundam I9. 
Fissure 196. per tertiam 20. 
Fistula 86. under an eschar 21. 
Fistula of lateral cartilage 88. Heat 80. 
Flat-foot 257. Heat-stroke 329. 
Foal-lameness 245. 7 Hemangioma 122. 
Folliculitis 324. Hemangiosarcoma 127. 
Formalin 259. Hematoma 65. 
Fractures 190. Hemiplegia 299. 
Fragilitas ossium 193. Hemoglobinemia following burns 
Free bodies 177. Hemophilia 16. [326. 
Freezing 328. Hemopis vorax 184. 
Foreign bodies 178. Hemorrhage 1. 
Fungus hematoides 123. arrest of 12, 
vasculosus 123. Hemorrhoids 315. 


Furunculosis 524. Hermaphroditism 335. 


Hernia 185. 

Histoid tumors Ioo. 
Heat-stroke 329. 

Hodgkin’s disease 125 

Horn, cutaneous 148. 

Horny cicatrix 22. 

Horse-leech 184. 
Hospital-gangrene 53. 
Hydrocele 282. 

Hydrops of tendon-sheaths 285. 


INDEX 


Hygromata of mucous bursz 280. 


of tendon-sheaths 275. 
Hyperonychia 337. 
Hyperostoses I1g. 
Hypoderma bovis 183. 
Hypodermoliths 183. 
Hypoplasia of the udder 337. 
Hypospadia 335. 
Hystriciasis 149. 


I 


Ichorous inflammation 77. 
' Ichthyosis 149. 
Incised wounds 6. 
Idiopathic fractures 193. 
Impaction I95. 
Impression 195. 
Inactivity, atrophy of 96. 
Incised wounds 6. 
Infectious tumors 152. 
Infection, septic 4o. 
Inflammation 72. 
Inflexion 188. 
Infraction 195. 
Inspiration-emphysema 331. 
Intestine, fistula of 87. 
calculus of 176. 
Intestinal hernia 185. 
Intestinal prolapse 189. 
Interstitial myositis 286. 
Intoxication, septic 41. 
Invagination 188. 
Inversion 188. 
Iodoform 59. 
Irrigation, permanent 81. 
Itrol 59. 
Ixodes ricinus 184. 


J 


Joint-bodies 258. 
Joint, caries of 243. 


contracture of 156. 
contusion of 253. 


diseases of 232. 


distorsion of 253. 
empyema of 237. 


galls of 235. 
hydrops of 235. 


inflammation of 233. 


luxation of 247. 


rheumatism of 244. 


sprain of 252. 
stiffness of 254. 
villi of 232. 


K 


Keloid rrr. 
Keratocele 148. 
Keratoma 148. 
Keratosis 148. 
Kyphosis 258. 


L 


Labium leporinum 335. 


Laceration 70. 
Lacerated wounds 7. 


Laryngeal tuberculosis 170. 
Lateral cartilage, fistula of 88. 


Leiomyoma 120. 
Leontiasis 229. 
Ligature 15. 


Lightning-stroke 329. 


Lipoma 113. 
Lipomasia 296. 


Liquefactive degeneration IgI. 
Longitudinal fractures 195. 


Lordosis 258. 
Lugol’s solution 59. 
Luxation 247. 
Lymphadenia 125. 
Lymphangioma 123. 
Lymphadenitis 318. 


343 


344 INDEX 


Lymphadenoma 124. 
Lymphangiosarcoma 127. 
Lymphangitis 316. 
Lymph-glands, inflammation 
of 318. 

Lymphoma 124. 
Lymph-cysts 317. 
Lysol 59. 

M 


Maceration gI. 
Macrochelia 124. 
Macrodactylia 229. 
Macroglossia 124. 
Macromazia 337. 
Macrosomia 338. 
Macula 323. 
Malformations 334. 
Malignant edema 49. 
Malignant lymphoma 124. 
Margaritoma 127. 
Massage 82. 
Mastitis 320. 
Medullary cancer 134. 
Melanocysts 128. 
Melanosarcoma 127, 131. 
Melanosis 127. 
Meliceris 149. 
Membrana pupillaris perseverans 
S371 
Mesarteritis 305. 
Metastasis 4o. 
Meteorism 332. 
Micrococcus ascoformans I61. 
Microphthalmus 337. 
Miescher’s tubules 184, 292. 
Milk-calculi 178. 
Milk-fistula 90 
Micromazia 337. 
Microphthalmus 337. 
Microsomia 338. 
Monoplegia 299. 
Monorchidism 334. 
Mortification 95. 
Mucous bursze 260. 
inflammation of 278. 


Mucous degeneration of the tur- 
binated bones 117. 


Mucous tumors 116. 
Mucous membrane, 
tion of 332. 
Mucous cysts 149. 
Mummification 95. 
Mures articulorum 258. 
Muscles 283. 
atrophy of 295. 
diseases of 283. 
hypertrophy of 297. 
inflammation of 286. 
luxation of 295. 
rheumatism of 287. 
ruptures of 293. 
tumors of 120. 
wounds of 23. 
Myeloid 126. 
Mycofibroma 161. 
Myoma 120. 
Myositis 286. 
Myxedema 117. 
Myxoma 116. 
Myxoscarcoma 126. 


N 


inflamma- 


Neevus 123. 

Nasal polypi Iog. 

Nearthrosis 250. 

Necrosis 9I, 95. 

Necrosis-bacillus 93. 

Nerves, diseases of 290. 
inflammation of 302. 
paralysis of 299. 
tumors of 121. 
wounds of, 24. 

Neuritis 302. 

Neuroma 122. 

Neurotomy 304. 


O 


Obliteration 96. 
Obturation-stenosis 97. 
Odontoma 150. 

(Estrus ovis 183. 
Omarthritis 242. 
Omentum, prolapse of 189. 


Omapagus parasiticus 338. 
Omphalitis 245. 
Onychogryposis 337. 
Onychoma 148. 

Open treatment of wounds 61. 


Organization of hematomata 67. 


Organization of thrombus 13. 
Organoid tumors Ioo. 
Ossifying myositis 29. 

periostitis 217. 
Osteoblusts Ig1. 
Osteoclasts IgI. 
Osteoma IIg. 
Osteomalacia 229. 
Osteomyelitis 216. 
Osteophytes I1g. 
Osteoporosis 228. 
Osteopsathyrosis 193. 
Osteosarcoma 128. 
Osteoschlerosis 221, 229. 
Ostitis 220. . 

P 


Pachyderma 112. 
Palatoschisis 335. 
Panaritium 33. 
Papilloma 144. 
Paralysis 299. 
Paraplegia 299. 
Parasites 182. 
Paresis 299. 
Paronychia 337. 
Pentastomum tzenoides 183. 
Percussion 82, 
Periarthritis 246. 
Periostitis 217. 
Perithelioma 127. 
Perodacty lus 338. 
Pes varus 257. 

- Petechia 65. 
Phagedena gI. 
Phagocytes 73. 
Pharyngeal lymphomata 157. 
Phimosis 335. 
Phlebectasia 314. 
Phlebitis 313. 
Phleboliths 14. 


INDEX 345 


Phlegmon 28. 

Phytobezoare 177. 
Pigmented sarcoma 127. 
Plaster-of-Paris bandage 212. 
Pneumatosis 331. 


- Pododermatitis 238.39 3 


Podotrochlitis 279. 
Poisoned wounds 8. 
Polyarthritis 234. 
Polydactylia 338. 
Polymelia 338. 
Polyodontia 336. 
Polypi 109. 

Pomphus 324. 

Preputial calculi 178. 
Pressure atrophy 96. 
Pressure necrosis gI. 
Priesnitz bandage 8o. 
Prognathism 335. 
Prolapsus 188. 

Prostatic calculi 178. 
Proteus 4I. 

Psammoma I27. 
Pseudo-arthrosis 209. 
Pseudo-carcinoma 138. 
Pseudo-glanders 3106. 
Pseudo-hermaphrodite 335. 
Pseudo-leukemia 125. 
Psorospermia 184. 
Ptomaines 41. 

Puerperal blackleg 54. 
Puerperal pyemia 44. 
Puerperal septicemia 43. 
Pulsion-diverticuluim 98. 
Pultaceous cysts 150. 
Punctured wounds 6. 


Pus 27. 
bacteria of 25. 


Pus bonum 27. 
Pus-cocci 25. 
Pus-fistule 87. 
Pustule 324 
Putresence gI. 
Pyemia 44. 

Pyemic arthritis 245. 
Pyocyanin 26. 


346 


Pyoktanin 61. 
Pyoxanthin 26. 


Q 


Quittor 88. 


R 


Rabies 54. 

Rachitis 230. 

Radial paralysis 301. 
Ranula 149. 

Ray-fungus 152. 
Regeneration of tissue 23. 
Renal calculi 175. 


Reposition of bone-fractures 211. 
Retention of bone-fractures 211. 


Retention-cysts 149. 
Rhabdomyoma 120. 
Rhinoschleroma 112. 
Ringbone 241. 
Rontgen-rays 203. 

Roseola 323. 
Round-celled sarcoma 126. 
Rupture 70. 


S 


Salicylic acid 60. 
Salivary fistula go. 
Salivary calculi 177. 
Sapremia 41. 
Saprophytes 41. 
Sarcoma 125. 
Sarcosporidia 184. 
Scab, healing under 21. 
Schleroderma 112, 
Schlerosis 112. 
Scirrhus 134. 

Scoliosis 258. 
Secretion-fistula go. 
Senile atrophy of bone 229. 
Septicemia 4o. 
Septicopyemia 4o. 
Septic phlegmon 30. 
Sequester gI. 
Schleroderma 112, 324. 
Schlerosis 112. 


INDEX 


Shot-wounds 8. 

Silver nitrate 59. 

Skin, inflammation of 323 
diseases of 323 

Spavin 239. 

Spermatic cord, fistula of 162. 

Sphacellus gr. 

Spina bifida 338. 

Spina ventosa 156. 

Spindle-celled sarcoma 126. 

Spiritus 60. 
bandage of 32. 

Stab-wound 6. 

Spontaneous bone-fracture I92. 
luxation 248. 

Spiroptera sanguinolenta 184. 

Splinter-fracture 195. 

Squamous-celled cancer 134. 

Stagnation edema 330. 

Staphylococcus 25. 

Stasis 73. 

Steatoma 114. 

Stilt-foot 256. 

Stenosis 97. 

Strangles 55. 

Streptococci 26. 

Streptococcus septicus 40. 

Stricture 97. 

Stringhalt 299. 

Strongylus armatus 184. 

Struma 147. 

Sublimate 58. 

Suffusion 65. 

Sun-stroke 329. 

Suppuration 25. 

Syndactylia 338. 

Synostosis 210. 

Synovitis 233. 


Tapping 82. 

Tannoform 59. 

Tar 60. 

Teeth, anomalies of 336 
Teleangiectasis 122. 


' Tendinitis 264. 


INDEX 347 


Tendons 259. 
diseases of 264. 
inflammation of 264. 
luxation of 270. 
necrosis of 270. 
rupture of 267. 
wounds of 23. 

Tendon-sheath 260. 
galls of 275. 
inflammation of 272. 

Tendinous stilt-foot 266. 

Tendovaginitis 272. 

Tenonitis 264. 

Teratoid tumors Ico. 

Teratoma 100. 

Tetanus 51. 
bacillus of 52. 

Thioform 60. 

Thrombosis of femoral arteries 308: 

Thrombus 13. 

Ticks 184. 

Tooth-follicle cyst 150. 

Tooth-fistula 89. 

Tooth-teratoma I50. 

Torsion I5. 

Traction-diverticulum 98. 

Transplantation 63. 

Trigeminus, paralysis of 301. 

Triorchid 334. 

Trismus 51. 

Tuberculosis 166. 

Tumor 98. 

Tumor albus 243. 
cavernosus 133. 
fibrosus 68. 

Tyloma 112. 

Tympanitis 332. 


U 


Udder, actinomycosis of 159. 
botryomycosis of 163. 
tuberculosis of 167. 

Ulcer 84. 


Ulceration 84. 
Urachus, cvstic 335. 
fistula of 335 

Urinary fistula go. 

Urinary calculus 175. 

Urticaria 324 

Uterus, prolapse of rgo. 
tuberculosis of 170. 


V 


Vagina, prolapse of 189. 
Vaporization of uterus 16. 
Varix 314. 
Veins, dilitation of 314. 
inflammation of 313. 
Venous calculi 14. 
Verruca 144. 
Vessel-tumors 122. 
Villous cancer 134. 


WwW 


Warmth 8o. 
Warts 144. 
Wildseuche 55. 
Winddorn 156. 
Withers, fistula of 89. 
Wolf’s jaw 335. 
Wooden-tongue 155. 
Wounds I. 
bandaging of 61. 
diphtheritic 53. 
healing of 17. 
treatment of 55. 
Wound fever 37. 
Wound infection diseases 25. 


X 
Xanthoma 127. 
oh 


Zestocausis 16. 


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